Healthcare Provider Details

I. General information

NPI: 1689344095
Provider Name (Legal Business Name): MONA G BURDEN-BLUNT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EMANCIPATION DR
HAMPTON VA
23667-3116
US

IV. Provider business mailing address

555 BELAIRE AVE STE 350
CHESAPEAKE VA
23320-4789
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9961
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013205
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: