Healthcare Provider Details

I. General information

NPI: 1003477282
Provider Name (Legal Business Name): ANNA LEIGH BURGDORF BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 CROWNPOINT EXECUTIVE DR STE E
CHARLOTTE NC
28227-6725
US

IV. Provider business mailing address

6711 CONSTITUTION LN
CHARLOTTE NC
28210-4217
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax:
Mailing address:
  • Phone: 706-207-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-33636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: