Healthcare Provider Details

I. General information

NPI: 1699926642
Provider Name (Legal Business Name): ELIZABETH ANN BURCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-5140
  • Fax:
Mailing address:
  • Phone: 919-636-2377
  • Fax: 336-562-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007742
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: