Provider Demographics
NPI:1467897694
Name:BURKETT, LISA F (NCAC, CAC II, SAP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:F
Last Name:BURKETT
Suffix:
Gender:F
Credentials:NCAC, CAC II, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 GREGG AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501
Mailing Address - Country:US
Mailing Address - Phone:843-665-9349
Mailing Address - Fax:
Practice Address - Street 1:601 GREGG AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4316
Practice Address - Country:US
Practice Address - Phone:843-665-9349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)