Provider Demographics
NPI:1750662649
Name:BERGEN, DALONDRIC RACEL SR (LCPC)
Entity Type:Individual
Prefix:
First Name:DALONDRIC
Middle Name:RACEL
Last Name:BERGEN
Suffix:SR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 HILLVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-5409
Mailing Address - Country:US
Mailing Address - Phone:432-207-0420
Mailing Address - Fax:
Practice Address - Street 1:2013 24TH ST W APT 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2839
Practice Address - Country:US
Practice Address - Phone:406-899-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional