Provider Demographics
NPI:1912362781
Name:BERDINE, DOROTHY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:
Last Name:BERDINE
Suffix:
Gender:F
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:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-1241
Mailing Address - Country:US
Mailing Address - Phone:360-460-8936
Mailing Address - Fax:
Practice Address - Street 1:3 BADGER ROAD
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-1241
Practice Address - Country:US
Practice Address - Phone:360-460-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health