Doctor Name: | GLORIA J. BURGESS |
NPI Number: | 1831258318 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED, LPCS |
License Number: | |
Business Practice Address: | 120 W Church St Ste A Batesburg, SC - 290062107 |
Business Phone Number: | 8039961500 |
Business Fax Number: | |
Mailing Address: | 301 Palmetto Park Blvd, LEXINGTON |
State: | SC |
Postal Code: | 290727872 |
Phone Number: | 8039961500 |
Fax Number: | |
NPI Enumeration Date: | 12/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |