Healthcare Provider Details

I. General information

NPI: 1083820278
Provider Name (Legal Business Name): KIMBERLEY DAWN BURCHETT BSSW, LADAC, NCACII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 THREE SPRINGS RD
NUNNELLY TN
37137-2670
US

IV. Provider business mailing address

124 E PALESTINE BLVD
MADISON TN
37115-4805
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-5040
  • Fax:
Mailing address:
  • Phone: 615-715-2167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLDC0000000262
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: