Individual
DR. ELWOOD JOHNSON BURGESS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
3824 BARRETT DR, SUITE 101, RALEIGH, NC 27609-7220
(919) 785-9944
(919) 785-9992
Mailing address
3509 HAWORTH DR, STE 404, RALEIGH, NC 27609-7237
(919) 785-9944
(919) 785-9992
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2249
NC
103TC0700X
Clinical Psychologist
2249
NC
103TC2200X
Clinical Child & Adolescent Psychologist
2249
NC
103TF0200X
Forensic Psychologist
2249
NC
103TR0400X
Rehabilitation Psychologist
2249
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0310E
BCBSNC
NC
01
—
176TU
BC/BS EFF 2/1/2013
NC
05
—
6000342
—
NC
Enumeration date
05/05/2007
Last updated
05/26/2018
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