Healthcare Provider Details

I. General information

NPI: 1265597181
Provider Name (Legal Business Name): KIM FELITA BURSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N SAINT ASAPH ST
ALEXANDRIA VA
22314-1912
US

IV. Provider business mailing address

16410 ELLIPSE TER
BOWIE MD
20716-3262
US

V. Phone/Fax

Practice location:
  • Phone: 703-838-4455
  • Fax: 703-838-5070
Mailing address:
  • Phone: 301-809-6009
  • Fax: 301-809-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002577
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC0137
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: