Healthcare Provider Details

I. General information

NPI: 1730771544
Provider Name (Legal Business Name): COLLEEN T BERGREN LMHC LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 RODGERS ROAD SUITE 306
WAKE FOREST NC
27587
US

IV. Provider business mailing address

3650 RODGERS ROAD SUITE 306
WAKE FOREST NC
27587
US

V. Phone/Fax

Practice location:
  • Phone: 919-346-3360
  • Fax:
Mailing address:
  • Phone: 919-346-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19165
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: