Burgess, Stacha N

Burgess, Stacha N is an sole proprietor health care provider with primary practice located at 108 Central Ave Ste 3 , Goose Creek SC 29445-3079. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Counselor is her primary health care specialty. Burgess, Stacha N can be contacted via phone (843) 789-4464.

Contact Information

Primary practice address
108 Central Ave Ste 3 Goose Creek SC 29445-3079
Phone: (843) 789-4464
Fax: (843) 970-2411
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 6073 South Carolina
Behavioral Health & Social Service Providers / Mental Health 101YM0800X LPCI-5514 South Carolina

Profile Details

NPI number 1265784037
LBN Legal business name Burgess, Stacha N
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 4th, 2012
Last updated Jun 15th, 2016 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265784037 NPPES
South Carolina MEDICAID 1760596480
South Carolina MEDICAID 1265784037

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