Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0810006349 | VA |
NPI | 1104112986 |
---|---|
Provider Name | Dr. Jeremiah W Burkhart |
First Address | Laurel Fork, VA 24352-0009 |
Second Address | Ferrum, VA 24088-2939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 29/01/2020 |