Individual
SAMICCA BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
187 W BROAD ST, SPARTANBURG, SC 29306-3234
(864) 582-7588
Mailing address
187 W BROAD ST, P.O. BOX 1252, SPARTANBURG, SC 29306-3234
(864) 582-7588
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AD10ST
SC
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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