Burgess, Elwood Johnson
Burgess, Elwood Johnson is an sole proprietor health care provider with primary practice located at 3824 Barrett Dr Suite 101, Raleigh NC 27609-7220. He recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Neuropsychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Forensic, Behavioral Health & Social Service Providers / Rehabilitation. Behavioral Health & Social Service Providers / Clinical Neuropsychologist is his primary health care specialty. Burgess, Elwood Johnson can be contacted via phone (919) 785-9944.Contact Information
Primary practice address
3824 Barrett Dr Suite 101
Raleigh NC 27609-7220
Phone: (919) 785-9944
Fax: (919) 785-9992
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Neuropsychologist | 103G00000X | 2249 | North Carolina |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 2249 | North Carolina |
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | 2249 | North Carolina |
| Behavioral Health & Social Service Providers / Forensic | 103TF0200X | 2249 | North Carolina |
| Behavioral Health & Social Service Providers / Rehabilitation | 103TR0400X | 2249 | North Carolina |
Profile Details
| NPI number | 1265644637 |
|---|---|
| LBN Legal business name | Burgess, Elwood Johnson |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 5th, 2007 |
| Last updated | May 26th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265644637 | NPPES |
| North Carolina | Other | 0310E | BCBSNC |
| North Carolina | Other | 176TU | BCBSNC |
| North Carolina | MEDICAID | 6000342 | BCBSNC |
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