Individual
MR. DOMINICK S BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PC
Contact information
Practice address
1404 PARK AVE W STE 2, ONTARIO, OH 44906-2719
(419) 522-6191
Mailing address
1404 PARK AVE W STE 2, ONTARIO, OH 44906-2719
(419) 522-6191
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0297823
—
OH
Enumeration date
03/11/2014
Last updated
10/24/2023
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