LISA VAN BERGEN (NPI# 1447723010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447723010 |
| Entity Type | Individual |
| Full Name | LISA VAN BERGEN |
| Credential | LPC, LAC |
| Practice Address |
1242 Pauline Ave Charleston SC 29412-4030 |
| Practice Telephone | 8437950238 |
| Practice Fax Number | 8437958290 |
| Mailing Telephone | 8437950238 |
| Mailing Fax Number | 8437958290 |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-01-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 2268 | SC | Behavioral Health & Social Service Providers |
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
520 | SC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | STATE LICENSURE BOARD | 2268 | 01 |
| Street Address |
1242 PAULINE AVE |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29412-4030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497999494 | Lynn Garlock Graves | Counselor | 1242 Pauline Ave, Charleston, SC 29412-4030 | 2009-04-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780219055 | Terra Rae Mchugh | Speech-Language Pathologist | 418 Folly Rd. Phc Rehab, Suite B, Charleston, SC 29412 | 2020-03-07 |
| 1437795747 | Brigitte Britt Huttemeyer | Nurse Practitioner | 678 Castle Pinckney Dr, Charleston, SC 29412 | 2019-11-21 |
| 1760956619 | Madison Culler, D.m.d., P.a. | Dentist | 211 Simmons Street, Mount Pleasant, SC 29412 | 2019-01-14 |
| 1366932717 | Harborview Speech Therapy, LLC | Speech-Language Pathologist | 783 Stebbins Street, Charleston, SC 29412 | 2018-05-11 |
| 1780193003 | Grace K Cotton | Speech-Language Pathologist | 1265 Marshview Dr, Charleston, SC 29412 | 2017-09-29 |
| 1639628449 | Matthew Husband | Occupational Therapist | 930 Folly Road, Suite B, Charleston, SC 29412 | 2016-09-22 |
| 1679941843 | Renee Poser | Pharmacist | 907 Folly Rd Suite A, James Island, SC 29412 | 2015-09-04 |
| 1508205717 | Amanda Marie Ashcraft | Dental Hygienist | 113 Wappoo Creek Drive Suite 5, James Island Dental Associates Pa, Charleston, SC 29412 | 2013-06-20 |
| 1104147818 | Glendolyn Harrison | Social Worker | 125e Wappoo Creek Drive, Suite 101e, Charleston, SC 29412 | 2010-06-16 |
| 1487986055 | Rachel E. Brunette | Physical Therapist | 418 B Folly Rd., Charleston, SC 29412 | 2010-02-08 |
| Find all providers in zip 29412 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881202778 | Sarah Deitz Ratliff | Counselor | 300 Capitol St Ste 1610, Charleston, WV 25301-1737 | 2020-07-17 |
| 1194341487 | Elizabeth Manigault | Counselor | 763 Meeting St Ste 200, Charleston, SC 29403-3146 | 2020-06-22 |
| 1689201196 | Chelsea Michelle Green | Counselor | 1812 Banbury Rd, Charleston, SC 29414-5941 | 2020-03-25 |
| 1437642139 | Timothy Charles Babick | Counselor | 801 Smith St Apt 16, Charleston, WV 25301-1249 | 2018-06-07 |
| 1497247001 | Jerica Wesley | Counselor | 300 Kenton Dr Ste 200, Charleston, WV 25311-1266 | 2018-05-31 |
| 1225557440 | Ravenel Therapeutic Counseling, LLC | Counselor | 29 Gamecock Ave Ste 100, Charleston, SC 29407-3366 | 2017-09-19 |
| 1780117804 | Amy Jackson | Counselor | 3590 Mary Ader Ave Apt 1021, Charleston, SC 29414-5792 | 2017-04-05 |
| 1013375708 | Avondale Therapy | Counselor | 845 Savannah Hwy, Suite 1c, Charleston, SC 29407-7202 | 2016-02-09 |
| 1366809097 | Kailee Place | Counselor | 22 Windermere Blvd Ste B, Charleston, SC 29407-7492 | 2016-01-26 |
| 1295075778 | Giovonnia Mccall | Counselor | 1521 Larry St, Charleston, SC 29406-3716 | 2013-02-21 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29412 |
Please comment or provide details below to improve the information on LISA VAN BERGEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.