Provider Demographics
NPI:1427766716
Name:DEWBERRY, KATRINA RENEE (LPC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:RENEE
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RIVENDELL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6917
Mailing Address - Country:US
Mailing Address - Phone:803-307-8923
Mailing Address - Fax:
Practice Address - Street 1:1817 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2630
Practice Address - Country:US
Practice Address - Phone:803-307-8923
Practice Address - Fax:803-403-0339
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8562101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty