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NPI Code Detail

MEDICARE: MS. WANDA J BURGER LPC

MEDICARE: MS. WANDA J BURGER LPC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1039NC
2101YP2500XProfessional Counselor5176NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1199630OTHERNCMEDCOST
21413EOTHERNCBLUECROSS BLUESHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
401-OTHERNCCIGNA

General Provider Information

NPI Number : 1114975430
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. WANDA J BURGER LPC
Provider Business Mailing Address
First Line : PO BOX 400
Second Line :
City : YADKINVILLE
State : NC
Zip : 27055-0400
Country : US
Telephone Number : 828-767-0811
Fax Number : 336-723-5218
Provider Business Practice Location Address
First Line : 624 W MAIN ST # 400
Second Line :
City : YADKINVILLE
State : NC
Zip : 27055-7804
Country : US
Telephone Number : 336-849-7975
Fax Number : 336-849-7767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 01/16/2019

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