Provider Demographics
NPI:1932602034
Name:BURNETT, ANQUINETT
Entity Type:Individual
Prefix:
First Name:ANQUINETT
Middle Name:
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 1:808 HARPER AVE NW STE 208
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5266
Mailing Address - Country:US
Mailing Address - Phone:828-394-9313
Mailing Address - Fax:828-572-2411
Practice Address - Street 1:808 HARPER AVE NW STE 208
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5266
Practice Address - Country:US
Practice Address - Phone:828-394-9313
Practice Address - Fax:828-572-2411
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13802101YM0800X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health