Individual
DOMINIQUE BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 JOE GIBSON DR, GIBSONVILLE, NC 27249-9811
(919) 508-4483
Mailing address
203 JOE GIBSON DR, GIBSONVILLE, NC 27249-9811
(919) 508-4483
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
374J00000X
Doula
—
—
Other
Enumeration date
06/11/2021
Last updated
04/27/2026
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