Basic Information
Provider Information
NPI: 1003146713
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURCH
FirstName: BELINDA
MiddleName: FAYE
NamePrefix: MS.
NameSuffix:  
Credential: MS, LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 615 NIXON DR
Address2:  
City: SANFORD
State: NC
PostalCode: 273308649
CountryCode: US
TelephoneNumber: 9197211832
FaxNumber: 9197760542
Practice Location
Address1: 615 NIXON DR
Address2:  
City: SANFORD
State: NC
PostalCode: 273308649
CountryCode: US
TelephoneNumber: 9197211832
FaxNumber: 9197760542
Other Information
ProviderEnumerationDate: 12/30/2009
LastUpdateDate: 11/23/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X7692NCY Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500X7692NCN Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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