Provider Demographics
NPI:1528769163
Name:BURNS, WANDA MARIE
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:MARIE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:MARIE
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:344 ROLLING HILL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6865
Mailing Address - Country:US
Mailing Address - Phone:980-219-0907
Mailing Address - Fax:
Practice Address - Street 1:344 ROLLING HILL RD STE 201
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6865
Practice Address - Country:US
Practice Address - Phone:980-219-0907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NCRBT-25-405514106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral