Provider Demographics
NPI:1942728530
Name:BURKE, ERICCA (LAC)
Entity Type:Individual
Prefix:
First Name:ERICCA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 GULL POINT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-5266
Mailing Address - Country:US
Mailing Address - Phone:910-622-6960
Mailing Address - Fax:
Practice Address - Street 1:1904 EASTWOOD RD STE 309
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5729
Practice Address - Country:US
Practice Address - Phone:910-509-0444
Practice Address - Fax:910-509-0449
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist