Individual
DR. RANDY SCOTT BURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1500 EAST WOODROW WILSON DRIVE, ADDICTIVE DISORDERS TREATMENT PROGRAM (116A4), VAMC, JACKSON, MS 39216
(601) 362-4471
(601) 364-1298
Mailing address
409 PROVISION PKWY, BRANDON, MS 39042-7909
(601) 362-4471
(601) 364-1298
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
40-13
MS
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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