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Individual

NICOLE THERESA BERG VI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LICSW

Contact information

Practice address
301 CORINTHIAN PL, DESTIN, FL 32541-5338
(210) 784-0397
Mailing address
301 CORINTHIAN PL, DESTIN, FL 32541-5338
(210) 784-0397

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
ISW17459
FL
101Y00000X
Counselor

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
409907
FL
Enumeration date
10/21/2022
Last updated
10/21/2022
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