Provider Demographics
NPI:1548774292
Name:BURNETTE, ANDREW RYAN (MA, MDIV, LPCA, NCC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RYAN
Last Name:BURNETTE
Suffix:
Gender:M
Credentials:MA, MDIV, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 YORKTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3454
Mailing Address - Country:US
Mailing Address - Phone:919-493-0959
Mailing Address - Fax:
Practice Address - Street 1:3209 YORKTOWN AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-3454
Practice Address - Country:US
Practice Address - Phone:919-493-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13440101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor