Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1040 | NC |
N | 101YM0800X | Mental Health Counselor | 5198 | NC |
N | 101YP2500X | Professional Counselor | 5198 | NC |
N | 225C00000X | Rehabilitation Counselor | 00090419 | NC |
NPI | 1316025711 |
---|---|
Provider Name | Mr. Brian Gonzalez-Burke |
First Address | Winterville, NC 28590-9310 |
Second Address | Winterville, NC 28590-9475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142HR | LPC (01) | NC |
6103146 | (05) | NC |