Provider Demographics
NPI:1033834494
Name:BURTON, AISHA (MED, MS, LCMHC)
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:MED, MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E PARK DR # A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1712
Mailing Address - Country:US
Mailing Address - Phone:919-410-6028
Mailing Address - Fax:
Practice Address - Street 1:124 E PARK DR # A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1712
Practice Address - Country:US
Practice Address - Phone:919-424-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17837101Y00000X, 101YM0800X
NCA17837101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health