Provider Demographics
NPI:1003950528
Name:BURG, BILLIE J (NRC, LMHC, NCGCII)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:J
Last Name:BURG
Suffix:
Gender:F
Credentials:NRC, LMHC, NCGCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 BAYWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4630
Mailing Address - Country:US
Mailing Address - Phone:727-392-1834
Mailing Address - Fax:727-392-4202
Practice Address - Street 1:5400 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-7317
Practice Address - Country:US
Practice Address - Phone:727-397-1924
Practice Address - Fax:727-392-4202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health