Individual
LISA VAN BERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LAC
Contact information
Practice address
1242 PAULINE AVE, CHARLESTON, SC 29412-4030
(843) 795-0238
(843) 795-8290
Mailing address
1242 PAULINE AVE, CHARLESTON, SC 29412-4030
(843) 795-0238
(843) 795-8290
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
2268
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
520
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2268
STATE LICENSURE BOARD
SC
Enumeration date
01/07/2019
Last updated
01/07/2019
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