Healthcare Provider Details

I. General information

NPI: 1235041161
Provider Name (Legal Business Name): VICTORIA ELIZABETH BERGSTROM MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 OLD GREENBRIER RD STE 6
CHESAPEAKE VA
23320-2648
US

IV. Provider business mailing address

2006 OLD GREENBRIER RD STE 6
CHESAPEAKE VA
23320-2648
US

V. Phone/Fax

Practice location:
  • Phone: 757-263-0434
  • Fax: 757-486-2563
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: