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General NPI Number Information
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NPI Number | 1861615890
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Entity Type | Individual
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Provider Name | REGINALD DAVID BURGESS MS, LCPC, LCADC
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 8830 ORCHARD TREE LN SUITE 127
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City | BALTIMORE
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State | MD
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Zip | 21286-2143
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Country | US
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Telephone | 443-632-3606
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Fax | 443-632-3652
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Provider Business Mailing Address
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Address Line | 8830 ORCHARD TREE LN STE 127
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City | BALTIMORE
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State | MD
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Zip | 21286-2143
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Country | US
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Telephone | 443-632-3606
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Fax | 443-632-3652
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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 | LCA407
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC2419
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License Number State | MD
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