Healthcare Provider Details

I. General information

NPI: 1316724461
Provider Name (Legal Business Name): ANTOINETTE M BURCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANTOINETTE M BURCH ANTOINETTE HARMON

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E SIX FORKS RD STE 117
RALEIGH NC
27609-7753
US

IV. Provider business mailing address

211 E SIX FORKS RD STE 117
RALEIGH NC
27609-7753
US

V. Phone/Fax

Practice location:
  • Phone: 919-833-8899
  • Fax: 919-833-8894
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29391
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020259
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: