Provider Demographics
NPI:1285256537
Name:BURLESON, LAUREN BROOKE (LCMHCA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BROOKE
Last Name:BURLESON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LILLINGTON DR APT 208
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3631
Mailing Address - Country:US
Mailing Address - Phone:910-740-5535
Mailing Address - Fax:
Practice Address - Street 1:9033 LAKE ROYALE
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-7208
Practice Address - Country:US
Practice Address - Phone:252-302-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health