Healthcare Provider Details

I. General information

NPI: 1891847489
Provider Name (Legal Business Name): CRYSTAL E BURKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 63 NORTH CLINIC STREET
ST. PAUL VA
24283
US

IV. Provider business mailing address

PO BOX 900
SAINT PAUL VA
24283-0900
US

V. Phone/Fax

Practice location:
  • Phone: 276-762-0770
  • Fax: 276-762-0678
Mailing address:
  • Phone: 276-762-0770
  • Fax: 276-762-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004835
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: