Provider Demographics
NPI:1841699162
Name:BURGIN, HOLLY (LCSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BURGIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 UNIVERSITY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6260
Mailing Address - Country:US
Mailing Address - Phone:919-433-0170
Mailing Address - Fax:919-226-0026
Practice Address - Street 1:8510 SIX FORKS RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3258
Practice Address - Country:US
Practice Address - Phone:919-260-8229
Practice Address - Fax:919-590-1982
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0086041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical