Provider Demographics
NPI:1952798209
Name:BURKE, EMMETT
Entity Type:Individual
Prefix:MR
First Name:EMMETT
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ASCENDING
Other - Middle Name:COUNSELING
Other - Last Name:SOLUTIONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 PRINCESS ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2268
Mailing Address - Country:US
Mailing Address - Phone:703-209-6217
Mailing Address - Fax:
Practice Address - Street 1:700 PRINCESS ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2268
Practice Address - Country:US
Practice Address - Phone:703-209-6217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2346-05-001Medicaid