Provider Demographics
NPI:1376587725
Name:BURLEW, RANDI DAWN (PHD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:DAWN
Last Name:BURLEW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 FAIRBROOK TER
Mailing Address - Street 2:APARTMENT 305
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-1848
Mailing Address - Country:US
Mailing Address - Phone:734-972-5010
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:MHSL OFFICE 10038A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102663103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist