Individual
PRESTON EUGENE BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IADC & CRADC
Contact information
Practice address
1523 S. FAIRMONT STREET, DAVENPORT, IA 52802-5351
(563) 322-2667
(563) 322-3671
Mailing address
1523 S. FAIRMONT STREET, DAVENPORT, IA 52802-5351
(563) 322-2667
(563) 322-3671
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11618-1121
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21R028
IA
101YA0400X
Addiction (Substance Use Disorder) Counselor
37377
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
7544
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11618-1121
ICADC
TX
01
—
21R028
IADC
IA
01
—
37377
CRADC
IL
01
—
7544
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX
Enumeration date
09/17/2008
Last updated
05/13/2022
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