Provider Demographics
NPI:1720149198
Name:BURSTON, JAMES LUTHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LUTHER
Last Name:BURSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 KNOWLES RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-8633
Mailing Address - Country:US
Mailing Address - Phone:336-342-3592
Mailing Address - Fax:
Practice Address - Street 1:857 KNOWLES RD
Practice Address - Street 2:1117 S. MAIN STREET
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8633
Practice Address - Country:US
Practice Address - Phone:336-342-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC325101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)