Individual
RENAE ANN BERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
206 MAPLE AVE E, MORA, MN 55051-1311
(132) 067-9358
(320) 679-3579
Mailing address
206 MAPLE AVE E, MORA, MN 55051-1311
(320) 679-3580
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301066
MN
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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