Healthcare Provider Details

I. General information

NPI: 1497313456
Provider Name (Legal Business Name): MICHAEL F BURGER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SAINT PATRICKS DR
WALDORF MD
20603-5529
US

IV. Provider business mailing address

6951 BENTON CT
KING GEORGE VA
22485-5469
US

V. Phone/Fax

Practice location:
  • Phone: 240-257-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC11805
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: