Individual
KEVIN M. BERGSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
12350 HALL SHOP RD, FULTON, MD 20759-9774
(800) 491-5369
(301) 774-3678
Mailing address
PO BOX 339, ASHTON, MD 20861-0339
(800) 491-5369
(301) 774-3678
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC7780
MD
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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