Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1326709718 |
---|---|
Provider Name | Wildine Burgess |
First Address | Bowie, MD 20720-4679 |
Second Address | Bowie, MD 20720-4679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2022 |
Last Update Date | 06/01/2022 |