Provider Demographics
NPI:1275739369
Name:BERG, ANNE M
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 LANDFALL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4257
Mailing Address - Country:US
Mailing Address - Phone:910-508-2463
Mailing Address - Fax:910-338-0001
Practice Address - Street 1:3205 RANDALL PKWY STE 205
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2569
Practice Address - Country:US
Practice Address - Phone:910-338-0001
Practice Address - Fax:910-341-7220
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health