Provider Demographics
NPI:1295702900
Name:BURNS, DIANA SUE (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:SUE
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 NORTHBEND RD
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9794
Mailing Address - Country:US
Mailing Address - Phone:336-404-2662
Mailing Address - Fax:
Practice Address - Street 1:4902 NORTHBEND RD
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9794
Practice Address - Country:US
Practice Address - Phone:336-404-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1301101YA0400X
NCC0052031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)