Provider Demographics
NPI:1790028959
Name:BERGWALL, SABINE FAJON (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:SABINE
Middle Name:FAJON
Last Name:BERGWALL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2325
Mailing Address - Country:US
Mailing Address - Phone:571-748-2824
Mailing Address - Fax:703-237-2083
Practice Address - Street 1:6400 ARLINGTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2325
Practice Address - Country:US
Practice Address - Phone:571-748-2824
Practice Address - Fax:703-237-2083
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health