Healthcare Provider Details

I. General information

NPI: 1124411707
Provider Name (Legal Business Name): MELISSA J BURNS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 GATEWAY DR STE 9-10C
BEL AIR MD
21014-4268
US

IV. Provider business mailing address

1209 BEAR HOLLOW CT
FOREST HILL MD
21050-2567
US

V. Phone/Fax

Practice location:
  • Phone: 443-819-0043
  • Fax:
Mailing address:
  • Phone: 410-652-0611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8213
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: