Provider Demographics
NPI:1437882784
Name:BURTS, DEWAYNE (CDAC-I)
Entity Type:Individual
Prefix:
First Name:DEWAYNE
Middle Name:
Last Name:BURTS
Suffix:
Gender:M
Credentials:CDAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7937 LAKE STONE CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-4086
Mailing Address - Country:US
Mailing Address - Phone:845-866-3447
Mailing Address - Fax:
Practice Address - Street 1:4191 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1411
Practice Address - Country:US
Practice Address - Phone:470-704-5010
Practice Address - Fax:470-704-5111
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1407101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)