Healthcare Provider Details

I. General information

NPI: 1407108590
Provider Name (Legal Business Name): CHRISTINE BERGER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8186 LARK BROWN RD 302
ELKRIDGE MD
21075-6433
US

IV. Provider business mailing address

9651 WHITEACRE RD UNIT A4
COLUMBIA MD
21045-3533
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-4232
  • Fax:
Mailing address:
  • Phone: 410-428-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3001
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: