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General NPI Number Information
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NPI Number | 1760879407
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Entity Type | Individual
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Provider Name | DUSTIN BERGER B.S., CAP
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Gender | Male
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 750 S ORANGE BLOSSOM TRL SUITE 229
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City | ORLANDO
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State | FL
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Zip | 32805-3118
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Country | US
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Telephone | 407-745-5022
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Fax | 407-601-4302
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Provider Business Mailing Address
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Address Line | 750 S ORANGE BLOSSOM TRL SUITE 229
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City | ORLANDO
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State | FL
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Zip | 32805-3118
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Country | US
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Telephone | 407-745-5022
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Fax | 407-601-4302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000182
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License Number State | FL
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