Organization
CHARLES E. BURT, PH.D. AND ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ERNEST BURT PHD (PRESIDENT)
(703) 899-3290
Entity
Organization
Contact information
Practice address
1800 MICHAEL FARADAY DR STE 206, RESTON, VA 20190-5312
(703) 899-3290
(703) 723-9404
Mailing address
22563 FOREST MANOR DR, ASHBURN, VA 20148-6900
(703) 899-3290
(703) 723-9404
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810001508
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
031200
VALUE OPTIONS PROVIDER #
VA
01
—
107617
ANTHEM BXBS
VA
Enumeration date
02/07/2007
Last updated
02/29/2020
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