Basic Information
| Provider Information | |||||||||
| NPI: | 1306080023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURLESON | ||||||||
| FirstName: | DUSTIN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 STATE FARM RD | ||||||||
| Address2: | SUITE 508 | ||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286074917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282649007 | ||||||||
| FaxNumber: | 8282625687 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 BEECH STREET | ||||||||
| Address2: | |||||||||
| City: | NEWLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286570040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287335889 | ||||||||
| FaxNumber: | 8282625687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2009 | ||||||||
| LastUpdateDate: | 04/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7307 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.