Individual
MRS. LISA D BURNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW CAP
Contact information
Practice address
259 OAKDALE AVE EAST, CRESTVIEW, FL 32536
(850) 682-1234
Mailing address
396 GARDEN ST, CRESTVIEW, FL 32536-1734
(850) 398-6173
(850) 398-6199
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2871
FL
1041C0700X
Clinical Social Worker
SW 6803
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
766762100
—
FL
Enumeration date
09/27/2006
Last updated
04/27/2018
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