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Individual
MR. REGINALD DAVID BURGESS
Active
Individual
MR. REGINALD DAVID BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LCPC, LCADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA407
MD
101YM0800X
Mental Health Counselor
Primary
LC2419
MD
Other
Enumeration date
04/10/2007
Last updated
09/02/2009
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