Provider Demographics
NPI:1922521665
Name:BERGLAND, M CHRISTY (LCPC)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:CHRISTY
Last Name:BERGLAND
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 1:3514 CLIPPER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1402
Mailing Address - Country:US
Mailing Address - Phone:410-467-4922
Mailing Address - Fax:
Practice Address - Street 1:3514 CLIPPER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1402
Practice Address - Country:US
Practice Address - Phone:410-467-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health