Provider Demographics
NPI:1073299954
Name:BURNETTE, NICOLETTE D (LISW)
Entity type:Individual
Prefix:MRS
First Name:NICOLETTE
Middle Name:D
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MISS
Other - First Name:NICOLETTE
Other - Middle Name:D
Other - Last Name:BOOKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 8532
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202
Mailing Address - Country:US
Mailing Address - Phone:803-238-6856
Mailing Address - Fax:
Practice Address - Street 1:2117 GERVAIS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-744-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC172211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical