Provider Demographics
NPI:1386917805
Name:BURTON, DARRELL CORNELIUS (LCSW)
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:CORNELIUS
Last Name:BURTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 RAVEN RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6774
Mailing Address - Country:US
Mailing Address - Phone:919-845-9756
Mailing Address - Fax:919-834-2407
Practice Address - Street 1:2220 RAVEN RD UNIT 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6774
Practice Address - Country:US
Practice Address - Phone:919-845-9756
Practice Address - Fax:919-834-2407
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0070351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical