| Doctor Name: | MRS. CANDEE LYNN BERGSTROM |
| NPI Number: | 1083703219 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | C005383 |
| Business Practice Address: | 8200 Ave. B Fort Lee, VA - 238011717 |
| Business Phone Number: | 8047349143 |
| Business Fax Number: | |
| Mailing Address: | 6848 Bixby Ln., CHESTERFIELD |
| State: | VA |
| Postal Code: | 23838 |
| Phone Number: | 8045909206 |
| Fax Number: | |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C005383 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |