Provider Demographics
NPI:1114975430
Name:BURGER, WANDA J (LPC)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:J
Last Name:BURGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:J
Other - Last Name:BURGER LPC LCAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCS ICCS CCMC SAP
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0400
Mailing Address - Country:US
Mailing Address - Phone:828-767-0811
Mailing Address - Fax:336-723-5218
Practice Address - Street 1:624 W MAIN ST # 400
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7804
Practice Address - Country:US
Practice Address - Phone:336-849-7975
Practice Address - Fax:336-849-7767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1039101YA0400X
NC5176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC199630OtherMEDCOST
NC1413EOtherBLUECROSS BLUESHIELD
NC6103159Medicaid
NC01-OtherCIGNA