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General NPI Number Information
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NPI Number | 1114975430
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Entity Type | Individual
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Provider Name | WANDA J BURGER LPC
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 624 W MAIN ST # 400
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City | YADKINVILLE
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State | NC
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Zip | 27055-7804
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Country | US
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Telephone | 336-849-7975
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Fax | 336-849-7767
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Provider Business Mailing Address
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Address Line | PO BOX 400
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City | YADKINVILLE
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State | NC
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Zip | 27055-0400
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Country | US
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Telephone | 828-767-0811
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Fax | 336-723-5218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1039
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5176
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License Number State | NC
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