Organization
CHARLES E. BURT, PH.D. AND ASSOCIATES, P.C.
Active
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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