Healthcare Provider Details

I. General information

NPI: 1891361507
Provider Name (Legal Business Name): DAVID LEE BURGESS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 FORESTVILLE RD
RALEIGH NC
27616-8774
US

IV. Provider business mailing address

2920 FORESTVILLE RD STE 100 PMB4001
RALEIGH NC
27616
US

V. Phone/Fax

Practice location:
  • Phone: 910-319-1827
  • Fax:
Mailing address:
  • Phone: 910-319-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC016489
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: