Provider Demographics
NPI:1588742696
Name:BURNETTE, DEBORAH BULLOCK (MAED, LPC, LCAS,CCS)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:BULLOCK
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:MAED, LPC, LCAS,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1706
Mailing Address - Country:US
Mailing Address - Phone:252-443-4401
Mailing Address - Fax:252-972-4502
Practice Address - Street 1:852 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1706
Practice Address - Country:US
Practice Address - Phone:252-443-4401
Practice Address - Fax:252-972-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC460 LCAS101YA0400X
NC72 CCS101YA0400X
NC4052 LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)