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MICHAEL THOMAS BERGQUIST LPC

Professional >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1396263588

Individual Registrant:
 MICHAEL THOMAS BERGQUIST LPC
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1637 ATHENS HWY  GRAYSON, GA 30017-1768 US
Tel: 678-344-8268  Fax: 888-627-6444

Contact information for business:
1637 ATHENS HWY  GRAYSON, GA 30017-1768 US
Tel: 678-344-8268  Fax: 888-627-6444

Registration Information:
NPI: 1396263588
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YP2500XBehavioral Health & Social Service Providers
Counselor
Professional
GALPC008976

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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