Healthcare Provider Details

I. General information

NPI: 1851567176
Provider Name (Legal Business Name): CHRIS H BURRIS LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FRIAR TUCK RD
WINSTON SALEM NC
27104-1615
US

IV. Provider business mailing address

610 FRIAR TUCK RD
WINSTON SALEM NC
27104-1615
US

V. Phone/Fax

Practice location:
  • Phone: 336-816-7353
  • Fax: 336-722-9608
Mailing address:
  • Phone: 336-816-7353
  • Fax: 336-722-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2781
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number709
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: