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General NPI Number Information
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NPI Number | 1396972121
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Entity Type | Individual
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Provider Name | DENISE R BURGESS RN, MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 800 PENNSYLVANIA AVE
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City | CHARLESTON
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State | WV
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Zip | 25302
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Country | US
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Telephone | 304-388-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 800 PENNSYLVANIA AVE
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City | CHARLESTON
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State | WV
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Zip | 25302
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Country | US
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Telephone | 304-388-2158
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1813
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 29205
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License Number State | WV
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