Provider Demographics
NPI:1871653402
Name:BURLISON, URSULA MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:MARIA
Last Name:BURLISON
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 1:1421 E BROAD ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1968
Mailing Address - Country:US
Mailing Address - Phone:919-607-7430
Mailing Address - Fax:919-557-0858
Practice Address - Street 1:367 W CENTER ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-5902
Practice Address - Country:US
Practice Address - Phone:919-607-7430
Practice Address - Fax:919-557-0858
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS53163Medicare UPIN
FLE0522AMedicare ID - Type Unspecified