Provider Demographics
NPI:1164982534
Name:BURRELL, SHAQUAILA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAQUAILA
Middle Name:
Last Name:BURRELL
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 1:5312 LAKE PLACID DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1952
Mailing Address - Country:US
Mailing Address - Phone:318-510-7671
Mailing Address - Fax:
Practice Address - Street 1:5312 LAKE PLACID DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1952
Practice Address - Country:US
Practice Address - Phone:318-510-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical