Provider Demographics
NPI:1619292380
Name:BURGESS, IRENE (LPC)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 S LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5823
Mailing Address - Country:US
Mailing Address - Phone:336-227-5476
Mailing Address - Fax:336-437-1898
Practice Address - Street 1:142 S LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5823
Practice Address - Country:US
Practice Address - Phone:336-227-5476
Practice Address - Fax:336-437-1898
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6558101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor