Individual
JACKIE BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSSA
Contact information
Practice address
166 PAWTUCKET AVE, PAWTUCKET, RI 02860-3811
(401) 722-4644
(401) 722-5280
Mailing address
166 PAWTUCKET AVE, PAWTUCKET, RI 02860-3811
(401) 722-4644
(401) 722-5280
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GH56996
—
RI
Enumeration date
10/30/2012
Last updated
10/30/2012
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