Provider Demographics
NPI:1578548400
Name:BERGERT, REBECCA RAE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RAE
Last Name:BERGERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 CHEROKEE ST NW STE 202
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6789
Mailing Address - Country:US
Mailing Address - Phone:770-429-4988
Mailing Address - Fax:770-824-9992
Practice Address - Street 1:3745 CHEROKEE ST NW STE 202
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6789
Practice Address - Country:US
Practice Address - Phone:770-429-4988
Practice Address - Fax:770-824-9992
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional