Individual
ELLEN BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPA
Contact information
Practice address
600 JACKSON ST, ROANOKE RAPIDS, NC 27870-2604
(252) 537-6164
(252) 537-9199
Mailing address
PO BOX 2161, ROANOKE RAPIDS, NC 27870-7161
(252) 537-6164
(252) 537-9199
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0693
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0693
NC PSYCHOLOGY BOARD
NC
Enumeration date
05/12/2011
Last updated
05/12/2011
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