Healthcare Provider Details

I. General information

NPI: 1356112007
Provider Name (Legal Business Name): DESIREE BURNS LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 HARRISON AVE
ELKINS WV
26241-3608
US

IV. Provider business mailing address

180 WASHBOARD LN
MILL CREEK WV
26280-1105
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-9450
  • Fax:
Mailing address:
  • Phone: 575-915-9243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW032517419
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: