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General NPI Number Information
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NPI Number | 1700093580
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Entity Type | Organization
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Legal Business Name | TOMIE C. BURDINE AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 331 S WASHINGTON AVE
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City | GREENVILLE
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State | MS
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Zip | 38701-4720
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Country | US
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Telephone | 662-332-5060
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Fax | 662-332-6715
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Provider Business Mailing Address
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Address Line | 331 S WASHINGTON AVE
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City | GREENVILLE
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State | MS
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Zip | 38701-4720
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Country | US
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Telephone | 662-332-5060
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Fax | 662-332-6715
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Authorized Official
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Title or Position | PRESIDENT
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Name | TOMIE C BURDINE
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Credential | LCSW
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Telephone | 662-332-5060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C4544
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License Number State | MS
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