MEDICARE: MRS. DEBORAH BULLOCK BURNETTE MA.ED, LPC, LCAS,CCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	460 LCAS	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	72 CCS	NC
3	101YP2500X	Professional Counselor	4052 LPC	NC

General Provider Information

NPI Number	:	1588742696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH BULLOCK BURNETTE MA.ED, LPC, LCAS,CCS

Provider Business Mailing Address
First Line	:	852 COUNTRY CLUB RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1706
Country	:	US
Telephone Number	:	252-443-4401
Fax Number	:	252-972-4502

Provider Business Practice Location Address
First Line	:	852 COUNTRY CLUB RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1706
Country	:	US
Telephone Number	:	252-443-4401
Fax Number	:	252-972-4502

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	05/15/2012

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