Provider Demographics
NPI:1700093580
Name:TOMIE C. BURDINE AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:TOMIE C. BURDINE AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURDINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-332-5060
Mailing Address - Street 1:331 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4720
Mailing Address - Country:US
Mailing Address - Phone:662-332-5060
Mailing Address - Fax:662-332-6715
Practice Address - Street 1:331 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4720
Practice Address - Country:US
Practice Address - Phone:662-332-5060
Practice Address - Fax:662-332-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC4544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty