Provider Demographics
NPI:1265974166
Name:BERGMAN, DEBRA M (LMFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 BUTEO RDG
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-9327
Mailing Address - Country:US
Mailing Address - Phone:336-708-5325
Mailing Address - Fax:
Practice Address - Street 1:78 MERRELL RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-7567
Practice Address - Country:US
Practice Address - Phone:336-708-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000743106H00000X
NC1786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist