Provider Demographics
NPI:1689873416
Name:BERGER, SALLY D (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:D
Last Name:BERGER
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 1:420 N CENTER DR
Mailing Address - Street 2:SUITE 141
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4007
Mailing Address - Country:US
Mailing Address - Phone:757-466-0700
Mailing Address - Fax:757-461-4826
Practice Address - Street 1:420 N CENTER DR
Practice Address - Street 2:SUITE 141
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4007
Practice Address - Country:US
Practice Address - Phone:757-466-0700
Practice Address - Fax:757-461-4826
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional