Provider Demographics
NPI:1548002611
Name:BURDICK, HOLLY A (MS, MA)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:A
Last Name:BURDICK
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2286 BETHABARA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-2639
Mailing Address - Country:US
Mailing Address - Phone:336-215-4004
Mailing Address - Fax:
Practice Address - Street 1:2286 BETHABARA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2639
Practice Address - Country:US
Practice Address - Phone:336-215-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator