Provider Demographics
NPI:1265844864
Name:BURK, NELDA (LBSW)
Entity Type:Individual
Prefix:
First Name:NELDA
Middle Name:
Last Name:BURK
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 MARIA DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1805
Mailing Address - Country:US
Mailing Address - Phone:734-404-6006
Mailing Address - Fax:
Practice Address - Street 1:485 MARIA DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1805
Practice Address - Country:US
Practice Address - Phone:734-404-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680-206-8576171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator