MEDICARE: JACKIE C BURNEY

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1831072313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE C BURNEY

Provider Business Mailing Address
First Line	:	22 INDUSTRIAL PARK DR STE A
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2792
Country	:	US
Telephone Number	:	240-296-6273
Fax Number	:	240-296-6273

Provider Business Practice Location Address
First Line	:	22 INDUSTRIAL PARK DR STE A
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2792
Country	:	US
Telephone Number	:	240-296-6273
Fax Number	:	240-296-6273

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

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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Directions to “ JACKIE C BURNEY ” Practice Location

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