Individual provider Active NPI

Elizabeth Jane Burdick, LPC

  • Professional Counselor
  • Rock Hill, SC
National Provider Identifier
1528247491
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2779 Issued in NC
Practice address
250 Piedmont Boulevard
Rock Hill, SC 29732
Phone
(803) 329-3177
Fax
(803) 329-3319
NPI assigned
Oct 29, 2007
Last updated
Nov 2, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 2779 NC Primary

Addresses

Primary practice location

250 Piedmont Boulevard
Rock Hill, SC 29732

Mailing address

250 Piedmont Boulevard
Rock Hill, SC 29732
Phone (803) 329-3177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240116003628 NC Practitioner - Mental Health Counselor 1456703354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2779NCMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
South Carolina Dept of Mental Health Accounting Office Past Accepting new patients
Shine Medical Providers PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lisa.burdick.1@30520.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288656000000",
    "number": "1528247491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 PIEDMONT BOULEVARD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "29732",
            "telephone_number": "803-329-3177",
            "fax_number": "803-329-3319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PIEDMONT BOULEVARD",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "29732",
            "telephone_number": "803-329-3177",
            "fax_number": "803-329-3319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURDICK",
        "first_name": "ELIZABETH",
        "middle_name": "JANE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-29",
        "last_updated": "2010-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "2779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.