Provider Demographics
NPI:1386513356
Name:BERTON, CAROL ELAINE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ELAINE
Last Name:BERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:BERTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCMHCA
Mailing Address - Street 1:212 CANTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5880
Mailing Address - Country:US
Mailing Address - Phone:248-396-8810
Mailing Address - Fax:
Practice Address - Street 1:1118 SAM NEWELL RD STE D4
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5162
Practice Address - Country:US
Practice Address - Phone:248-396-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health