Provider Demographics
NPI:1891361507
Name:BURGESS, DAVID LEE (MSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:BURGESS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 FOUNTAIN GROVE CIR APT 107
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3192
Mailing Address - Country:US
Mailing Address - Phone:336-979-2508
Mailing Address - Fax:
Practice Address - Street 1:3505 VILLAGE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4514
Practice Address - Country:US
Practice Address - Phone:910-500-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0164891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical