Healthcare Provider Details

I. General information

NPI: 1699026070
Provider Name (Legal Business Name): BRANDI GOSS BURCHETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13935 POINT LOOKOUT RD
RIDGE MD
20680-3220
US

IV. Provider business mailing address

13935 POINT LOOKOUT RD
RIDGE MD
20680-3220
US

V. Phone/Fax

Practice location:
  • Phone: 919-268-6900
  • Fax:
Mailing address:
  • Phone: 919-268-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC14190
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7773
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC14190
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC14190
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7773
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC14190
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7773
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: