MEDICARE: DIANA SUE BURNS LCSW, LCAS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1301	NC
2	1041C0700X	Clinical Social Worker	C005203	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295702900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA SUE BURNS LCSW, LCAS

Provider Business Mailing Address
First Line	:	4902 NORTHBEND RD
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9794
Country	:	US
Telephone Number	:	336-404-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	4902 NORTHBEND RD
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9794
Country	:	US
Telephone Number	:	336-404-2662
Fax Number	:

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	11/18/2008

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