Individual provider Active NPI

David Lee Burgess, LCSW

  • Clinical Social Worker
  • Raleigh, NC
National Provider Identifier
1891361507
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C016489 Issued in NC
Practice address
2920 Forestville Rd
Raleigh, NC 27616-8774
Phone
(910) 319-1827
NPI assigned
Jun 2, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pastoral CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP1600X
Clinical Social Worker 1041C0700X C016489 NC Primary

Addresses

Primary practice location

2920 Forestville Rd
Raleigh, NC 27616-8774

Mailing address

2920 Forestville Rd Ste 100 Pmb4001
Raleigh, NC 27616
Phone (910) 319-1827

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
C016489NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Salisbury Vamc PastSince Jan 21, 2022 Accepting new patients

Organizations & group practices 1

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": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1891361507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 FORESTVILLE RD STE 100 PMB4001",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "27616",
            "telephone_number": "910-319-1827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 FORESTVILLE RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276168774",
            "telephone_number": "910-319-1827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "DAVID",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-02",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C016489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.