Healthcare Provider Details

I. General information

NPI: 1316025711
Provider Name (Legal Business Name): BRIAN GONZALEZ-BURKE LPC, LCAS, CRC, MTBC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W FIRETOWER RD
WINTERVILLE NC
28590-9475
US

IV. Provider business mailing address

2385 BROCK AVE
WINTERVILLE NC
28590-9310
US

V. Phone/Fax

Practice location:
  • Phone: 252-341-1649
  • Fax:
Mailing address:
  • Phone: 252-341-1649
  • Fax: 252-353-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1040
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5198
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number06087
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5198
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00090419
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: