Provider Demographics
NPI:1720301807
Name:BURNETT, BRANDY TAISHA
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:TAISHA
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 RABBIT RUN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-2782
Mailing Address - Country:US
Mailing Address - Phone:919-412-7675
Mailing Address - Fax:
Practice Address - Street 1:2020 RABBIT RUN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2782
Practice Address - Country:US
Practice Address - Phone:919-412-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor