Provider Demographics
NPI:1144629312
Name:BERRY II, RANCE A II (LPC, CSOTS)
Entity type:Individual
Prefix:
First Name:RANCE
Middle Name:A
Last Name:BERRY II
Suffix:II
Gender:M
Credentials:LPC, CSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 QUARRIER ST
Mailing Address - Street 2:STE 414
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2338
Mailing Address - Country:US
Mailing Address - Phone:304-340-3676
Mailing Address - Fax:304-340-3688
Practice Address - Street 1:1219 OHIO AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3019
Practice Address - Country:US
Practice Address - Phone:866-308-2307
Practice Address - Fax:855-314-6877
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health