Healthcare Provider Details

I. General information

NPI: 1316326879
Provider Name (Legal Business Name): SAMANTHA BURGGRAF MS, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GARNER RD SUITE 113
RALEIGH NC
27610-4687
US

IV. Provider business mailing address

2101 GARNER RD SUITE 113
RALEIGH NC
27610-4687
US

V. Phone/Fax

Practice location:
  • Phone: 919-832-4453
  • Fax: 919-829-1357
Mailing address:
  • Phone: 919-832-4453
  • Fax: 919-829-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-21754
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: