Provider Demographics
NPI:1689498164
Name:BURKE, ALISTAIR GARETH (LCMHCA)
Entity type:Individual
Prefix:
First Name:ALISTAIR
Middle Name:GARETH
Last Name:BURKE
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 ELK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DEEP GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28618-8217
Mailing Address - Country:US
Mailing Address - Phone:828-656-5852
Mailing Address - Fax:828-372-4628
Practice Address - Street 1:9039 ELK CREEK RD
Practice Address - Street 2:
Practice Address - City:DEEP GAP
Practice Address - State:NC
Practice Address - Zip Code:28618-8217
Practice Address - Country:US
Practice Address - Phone:828-656-5852
Practice Address - Fax:828-372-4628
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional