Provider Demographics
NPI:1942533807
Name:BURGESS, ANDREA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:BURGESS
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 1:203 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-2421
Mailing Address - Country:US
Mailing Address - Phone:828-337-8468
Mailing Address - Fax:
Practice Address - Street 1:105 LANIER LANE
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778
Practice Address - Country:US
Practice Address - Phone:828-337-8468
Practice Address - Fax:828-338-5099
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0069211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical