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NPI Code Detail

MEDICARE: ELIJAH BURNER LCMHCA, NCC

MEDICARE: ELIJAH BURNER LCMHCA, NCC
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 CounselorA18696NC

General Provider Information

NPI Number : 1649967613
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIJAH BURNER LCMHCA, NCC
Provider Business Mailing Address
First Line : 600 WILLARD ST UNIT 542
Second Line :
City : DURHAM
State : NC
Zip : 27701-4599
Country : US
Telephone Number : 661-444-3164
Fax Number :
Provider Business Practice Location Address
First Line : 1777 FORDHAM BLVD STE 204
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27514-5885
Country : US
Telephone Number : 919-283-3137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2023
Last Update Date : 04/20/2023

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