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General NPI Number Information
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NPI Number | 1700992062
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Entity Type | Individual
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Provider Name | DOUGLAS DUBOIS BURGESS L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 1551 BISHOP ST SUITE A-160
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4635
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Country | US
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Telephone | 805-269-1500
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Fax | 805-269-1585
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Provider Business Mailing Address
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Address Line | 2050 S BLOSSER RD
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City | SANTA MARIA
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State | CA
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Zip | 93458-7310
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Country | US
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Telephone | 805-361-8028
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Fax | 805-361-8097
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 13534
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License Number State | CA
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