Healthcare Provider Details

I. General information

NPI: 1053878694
Provider Name (Legal Business Name): DAVID L BURNEY CDCA.177160
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 STANLEY ST
COAL GROVE OH
45638-3148
US

IV. Provider business mailing address

186 STANLEY ST
COAL GROVE OH
45638-3148
US

V. Phone/Fax

Practice location:
  • Phone: 740-237-4981
  • Fax: 877-325-2816
Mailing address:
  • Phone: 740-237-4981
  • Fax: 866-475-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.172022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: