Active NPI
Addis Berek, LGPC
- Professional Counselor
- Laurel, MD
National Provider Identifier
1104576008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LGP11836
- Practice address
- 13915 Shannon Ave
Laurel, MD 20707-5829 - Phone
- (301) 435-5221
- NPI assigned
- Mar 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LGP11836 | MD | Primary |
Addresses
Primary practice location
13915 Shannon Ave
Laurel, MD 20707-5829
Mailing address
13915 Shannon Ave
Laurel, MD 20707-5829
Phone (301) 435-5221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LGP11836 | MD | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648080000000",
"number": "1104576008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13915 SHANNON AVE",
"city": "LAUREL",
"state": "MD",
"postal_code": "207075829",
"telephone_number": "301-435-5221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13915 SHANNON AVE",
"city": "LAUREL",
"state": "MD",
"postal_code": "207075829",
"telephone_number": "301-435-5221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEREK",
"first_name": "ADDIS",
"name_prefix": "Dr.",
"credential": "LGPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-24",
"last_updated": "2022-03-24",
"certification_date": "2022-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MD",
"license": "LGP11836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.