MEDICARE: BARBARA BURDEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2778	OTHER	NC	LICENSING BOARD

General Provider Information

NPI Number	:	1053920116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA BURDEN

Provider Business Mailing Address
First Line	:	209 N CAROLE DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-4845
Country	:	US
Telephone Number	:	843-422-0212
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 N CAROLE DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-4845
Country	:	US
Telephone Number	:	843-422-0212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	07/24/2020

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Directions to “ BARBARA BURDEN ” Practice Location

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