Provider Demographics
NPI:1053330555
Name:BURKE, BETTY JANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JANE
Last Name:BURKE
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 1:6620 SHINGLE RIDGE RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6946
Mailing Address - Country:US
Mailing Address - Phone:540-989-9537
Mailing Address - Fax:540-989-3498
Practice Address - Street 1:3433 BRAMBLETON AVE
Practice Address - Street 2:SUITE 109 B
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6515
Practice Address - Country:US
Practice Address - Phone:540-989-9537
Practice Address - Fax:540-989-3498
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5404177Medicaid