Provider Demographics
NPI:1770951733
Name:BURNETTE, NOLA COVINGTON (LISW-CP)
Entity type:Individual
Prefix:
First Name:NOLA
Middle Name:COVINGTON
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 EVELYN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5212
Mailing Address - Country:US
Mailing Address - Phone:803-216-0850
Mailing Address - Fax:803-216-0420
Practice Address - Street 1:409 EVELYN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5212
Practice Address - Country:US
Practice Address - Phone:803-216-0850
Practice Address - Fax:803-216-0420
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical