Active NPI
Lisa Van Bergen, LPC, LAC
- Counselor
- Charleston, SC
National Provider Identifier
1447723010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 2268
- Practice address
- 1242 Pauline Ave
Charleston, SC 29412-4030 - Phone
- (843) 795-0238
- Fax
- (843) 795-8290
- NPI assigned
- Jan 7, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 520 | SC | |
| Counselor | 101Y00000X | 2268 | SC | Primary |
Addresses
Primary practice location
1242 Pauline Ave
Charleston, SC 29412-4030
Mailing address
1242 Pauline Ave
Charleston, SC 29412-4030
Phone (843) 795-0238
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2268 | Other | SC | STATE LICENSURE BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2268 | SC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546819200000",
"number": "1447723010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1242 PAULINE AVE",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294124030",
"telephone_number": "843-795-0238",
"fax_number": "843-795-8290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1242 PAULINE AVE",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294124030",
"telephone_number": "843-795-0238",
"fax_number": "843-795-8290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN BERGEN",
"first_name": "LISA",
"credential": "LPC, LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-07",
"last_updated": "2019-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "SC",
"license": "520",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "SC",
"license": "2268",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSURE BOARD",
"identifier": "2268",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.