Provider Demographics
NPI:1033772140
Name:BURNES, SHUNDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHUNDRA
Middle Name:
Last Name:BURNES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 MAIN ST STE 300-50
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3098
Mailing Address - Country:US
Mailing Address - Phone:404-416-3547
Mailing Address - Fax:470-867-6898
Practice Address - Street 1:925 MAIN ST STE 300-50
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3098
Practice Address - Country:US
Practice Address - Phone:404-416-3547
Practice Address - Fax:470-867-6898
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0063171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical