Provider Demographics
NPI:1801443833
Name:BURNETT, DAVID MCCRARY (LADAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MCCRARY
Last Name:BURNETT
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 LAUREL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEAGLE
Mailing Address - State:TN
Mailing Address - Zip Code:37356-5023
Mailing Address - Country:US
Mailing Address - Phone:423-280-0756
Mailing Address - Fax:
Practice Address - Street 1:141 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2205
Practice Address - Country:US
Practice Address - Phone:423-280-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000001068101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)