Provider Demographics
NPI:1548997737
Name:BURKS, IRENE (LGPC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 JENNINGS MILL DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-6214
Mailing Address - Country:US
Mailing Address - Phone:301-343-9566
Mailing Address - Fax:
Practice Address - Street 1:14815 MANOR RD
Practice Address - Street 2:
Practice Address - City:MONKTON
Practice Address - State:MD
Practice Address - Zip Code:21111-2400
Practice Address - Country:US
Practice Address - Phone:410-205-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health