Healthcare Provider Details

I. General information

NPI: 1356524193
Provider Name (Legal Business Name): STEPHEN ERIC BURGESS LISW-CP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2007
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 PATTON AVE STE D
ASHEVILLE NC
28806-2652
US

IV. Provider business mailing address

411 OAK ST STERLING MEDICAL ASSOCIATES ATTN: CREDENTIALS
CINCINNATI OH
45219-2504
US

V. Phone/Fax

Practice location:
  • Phone: 828-225-3100
  • Fax:
Mailing address:
  • Phone: 513-984-1800
  • Fax: 513-984-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012784
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: