Provider Demographics
NPI:1518023118
Name:BARRY, CAROL A (MSW, LCSW, LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BARRY
Suffix:
Gender:F
Credentials:MSW, LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GRAYSON RD
Mailing Address - Street 2:.
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4345
Mailing Address - Country:US
Mailing Address - Phone:757-459-4640
Mailing Address - Fax:757-459-4643
Practice Address - Street 1:260 GRAYSON RD
Practice Address - Street 2:.
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4345
Practice Address - Country:US
Practice Address - Phone:757-459-4640
Practice Address - Fax:757-459-4643
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701-001469101YM0800X
VA0904-0018711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7118074Medicaid
VA7118074Medicaid
VA000081J52Medicare ID - Type Unspecified