Provider Demographics
NPI:1841152865
Name:JEAN JACQUES, BERLINE
Entity type:Individual
Prefix:
First Name:BERLINE
Middle Name:
Last Name:JEAN JACQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 HEWITT ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3606 HEWITT ST APT 2A
Practice Address - Street 2:APT 2A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2492
Practice Address - Country:US
Practice Address - Phone:407-272-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health