Tatiana L Bergstrom, MA, LSATP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

0718000337 Issued in VA

Practice address

4001 Prince William Pkwy Ste 301
Woodbridge, VA 22192-7667

Phone

(703) 688-8541

Fax

(703) 213-5025

NPI assigned

Oct 29, 2020

Last updated

Sep 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Mental Health of Virginia, LLC

  dba Ellie Mental Health

  • Clinical Social Worker
  • Woodbridge, VA
  • NPI 1962103549
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726790400000",
    "number": "1194325159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 PRINCE WILLIAM PKWY STE 301",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221927667",
            "telephone_number": "703-688-8541",
            "fax_number": "703-213-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 PRINCE WILLIAM PKWY STE 301",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221927667",
            "telephone_number": "703-688-8541",
            "fax_number": "703-213-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGSTROM",
        "first_name": "TATIANA",
        "middle_name": "L",
        "credential": "MA, LSATP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-29",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0718000337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bennett Home Care Agency
• Danielle Renee Benninghoff
• N'Dea Bryauna Benson
• Kambeez Berenji, MD
• Benjamin F Berger, B.S.
• Ruth Berhe, RED SEA NEMT
• Tanvi Beri, M.D.
• Bestcare Home Care Inc
• Bestpractices, Inc.
• Bethel Residential Services LLC

• Addiction (Substance Use Disorder) Counselor in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Addiction (Substance Use Disorder) Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.