Provider Demographics
NPI:1912313289
Name:BERRYMAN, PATRICIA S (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:S
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:TRISH
Other - Middle Name:
Other - Last Name:BERRYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:4115 COLUMBIA RD.
Mailing Address - Street 2:STE 5 PMB 264
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0410
Mailing Address - Country:US
Mailing Address - Phone:843-260-2109
Mailing Address - Fax:
Practice Address - Street 1:1036 LAKE MOULTRIE DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-7612
Practice Address - Country:US
Practice Address - Phone:843-260-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional