Provider Demographics
NPI:1114797677
Name:BURTON, SHWANNA (ABD, MS, LPC)
Entity Type:Individual
Prefix:
First Name:SHWANNA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:ABD, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 RAILROAD ST STE 6
Mailing Address - Street 2:
Mailing Address - City:STATHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30666-1808
Mailing Address - Country:US
Mailing Address - Phone:678-726-7106
Mailing Address - Fax:678-726-7107
Practice Address - Street 1:1920 RAILROAD ST STE 6
Practice Address - Street 2:
Practice Address - City:STATHAM
Practice Address - State:GA
Practice Address - Zip Code:30666-1808
Practice Address - Country:US
Practice Address - Phone:678-726-7106
Practice Address - Fax:678-726-7107
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014358101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional