Healthcare Provider Details

I. General information

NPI: 1285130690
Provider Name (Legal Business Name): ERIN LEE BURCHETT CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14572 US RTE 23
WAVERLY OH
45690-4569
US

IV. Provider business mailing address

PO BOX 108
IRONTON OH
45638-0108
US

V. Phone/Fax

Practice location:
  • Phone: 407-947-6727
  • Fax: 740-532-1715
Mailing address:
  • Phone: 740-532-1613
  • Fax: 740-532-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.166253
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: