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NPI Code Detail

MEDICARE: DEJA BURR

MEDICARE: DEJA BURR
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1487510913
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEJA BURR
Provider Business Mailing Address
First Line : 424 BOLLING DR
Second Line :
City : GOLDSBORO
State : NC
Zip : 27534-5532
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 890 S KERR AVE STE 200
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-4248
Country : US
Telephone Number : 843-212-6651
Fax Number : 910-378-9211
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2025
Last Update Date : 12/29/2025

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Directions to “ DEJA BURR ” Practice Location

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