Provider Demographics
NPI:1225757412
Name:BURCH, DESTINEE' ASRIAHNA
Entity Type:Individual
Prefix:
First Name:DESTINEE'
Middle Name:ASRIAHNA
Last Name:BURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 MAYFAIR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6223
Mailing Address - Country:US
Mailing Address - Phone:984-215-4067
Mailing Address - Fax:
Practice Address - Street 1:3708 MAYFAIR ST STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6223
Practice Address - Country:US
Practice Address - Phone:984-215-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0177591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical