Provider Demographics
NPI:1902843501
Name:BURD, JOHN ROBERT III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:BURD
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 GUM BRANCH RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6269
Mailing Address - Country:US
Mailing Address - Phone:910-989-0900
Mailing Address - Fax:910-989-0377
Practice Address - Street 1:824 GUM BRANCH RD
Practice Address - Street 2:SUITE O
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6269
Practice Address - Country:US
Practice Address - Phone:910-989-0900
Practice Address - Fax:910-989-0377
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12716OtherBLUE CROSS/BLUE SHIELD
NC6002014Medicaid
NC12716OtherBLUE CROSS/BLUE SHIELD