Provider Demographics
NPI:1306080023
Name:BURLESON, DUSTIN G (LPC)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:G
Last Name:BURLESON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 STATE FARM RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4917
Mailing Address - Country:US
Mailing Address - Phone:828-264-9007
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:360 BEECH STREET
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-0040
Practice Address - Country:US
Practice Address - Phone:828-733-5889
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional