Provider Demographics
NPI:1649967613
Name:BURNER, ELIJAH (LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:BURNER
Suffix:
Gender:M
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WILLARD ST UNIT 542
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4599
Mailing Address - Country:US
Mailing Address - Phone:661-444-3164
Mailing Address - Fax:
Practice Address - Street 1:1777 FORDHAM BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5885
Practice Address - Country:US
Practice Address - Phone:919-283-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health