Provider Demographics
NPI:1245775618
Name:BERGESON, COLIN (LCSW)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:BERGESON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 CROMWELL DR STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5436
Mailing Address - Country:US
Mailing Address - Phone:524-704-6392
Mailing Address - Fax:
Practice Address - Street 1:702 CROMWELL DR STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5436
Practice Address - Country:US
Practice Address - Phone:252-470-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0149361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC014936OtherSOCIAL WORK BOARD