Provider Demographics
NPI:1316025711
Name:GONZALEZ-BURKE, BRIAN (LPC, LCAS, CRC, MTBC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:GONZALEZ-BURKE
Suffix:
Gender:M
Credentials:LPC, LCAS, CRC, MTBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 BROCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9310
Mailing Address - Country:US
Mailing Address - Phone:252-341-1649
Mailing Address - Fax:252-353-1119
Practice Address - Street 1:104 W FIRETOWER RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9475
Practice Address - Country:US
Practice Address - Phone:252-341-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1040101YA0400X
NC5198101YP2500X, 101YM0800X
NC06087225A00000X
NC00090419225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142HROtherLPC
NC6103146Medicaid