Healthcare Provider Details

I. General information

NPI: 1578030029
Provider Name (Legal Business Name): HEATHER BURGESS NCC, LCMHCA, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CRISPIN CT STE 203D
ASHEVILLE NC
28803-8205
US

IV. Provider business mailing address

212 REGER AVE
SWANNANOA NC
28778-2122
US

V. Phone/Fax

Practice location:
  • Phone: 828-250-3700
  • Fax:
Mailing address:
  • Phone: 828-505-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA14387
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA14387
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: