Provider Demographics
NPI:1235800038
Name:BURCHETTE, WILLIAM ANTHONY
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:BURCHETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1905
Mailing Address - Country:US
Mailing Address - Phone:336-423-6140
Mailing Address - Fax:
Practice Address - Street 1:914 N ELM ST STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6319
Practice Address - Country:US
Practice Address - Phone:336-310-5098
Practice Address - Fax:336-860-1649
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)