Provider Demographics
NPI:1881620250
Name:BERKS COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:BERKS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:AXFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-373-4281
Mailing Address - Street 1:645 PENN STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601
Mailing Address - Country:US
Mailing Address - Phone:610-373-4281
Mailing Address - Fax:610-373-3779
Practice Address - Street 1:645 PENN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601
Practice Address - Country:US
Practice Address - Phone:610-373-4281
Practice Address - Fax:610-373-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA206900101YM0800X
PA223690101YM0800X
PA067063101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA543489000OtherMAGELLAN PROVIDER I.D.
PA001898953Medicaid
PA001937640OtherMA PROVIDER I.D.
PA001042570Medicaid
PA093397000OtherMAGELLAN
PA100737431Medicaid
PA2022751OtherAMERIHEALTH MERCY
PA1547737OtherGATEWAY CBHNP
PA2022751OtherAMERIHEALTH MERCY
PA055152Medicare UPIN
PA001042570Medicaid