Provider Demographics
NPI:1578613824
Name:BURGESS-JOHNSON, FRANCES WILLOWBROOK (LCSW)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:WILLOWBROOK
Last Name:BURGESS-JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 REGENT PARK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3727
Mailing Address - Country:US
Mailing Address - Phone:828-505-1762
Mailing Address - Fax:
Practice Address - Street 1:1316 PATTON AVE STE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2652
Practice Address - Country:US
Practice Address - Phone:828-225-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005719101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106735Medicaid