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General NPI Number Information
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NPI Number | 1578094140
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Entity Type | Individual
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Provider Name | MARCI SONDRA BURROUGHS PHD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 9111 CROSS PARK DR SUITE E111
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City | KNOXVILLE
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State | TN
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Zip | 37923-4506
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Country | US
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Telephone | 865-696-7332
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Fax | 865-761-8198
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Provider Business Mailing Address
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Address Line | 118 N PETERS RD STE 155
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City | KNOXVILLE
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State | TN
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Zip | 37923-4927
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Country | US
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Telephone | 865-696-7332
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Fax | 865-761-8198
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2109
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License Number State | TN
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