Provider Demographics
NPI:1457014052
Name:BURSON, MICHAEL R (LCMHCA, NCC, MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:BURSON
Suffix:
Gender:M
Credentials:LCMHCA, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 WHITEWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0432
Mailing Address - Country:US
Mailing Address - Phone:828-400-6014
Mailing Address - Fax:
Practice Address - Street 1:9609 WHITEWOOD TRL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0432
Practice Address - Country:US
Practice Address - Phone:828-400-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health