Provider Demographics
NPI:1174833479
Name:BURT, DONNA R (B A, MENTAL HEALTH C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:BURT
Suffix:
Gender:F
Credentials:B A, MENTAL HEALTH C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 918
Mailing Address - Street 2:1035 CHERAW ST.
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512
Mailing Address - Country:US
Mailing Address - Phone:843-454-0841
Mailing Address - Fax:843-454-0635
Practice Address - Street 1:207 COMMERCE AVE.
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709
Practice Address - Country:US
Practice Address - Phone:843-623-2229
Practice Address - Fax:843-623-2553
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC570840012OtherNEW DAY, INC. OF SPARTANBURG
SC405127Medicaid
SC405127Medicaid