Provider Demographics
NPI:1538493515
Name:BURNETT, AMY MARIE (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1640 POWERS FERRY ROAD SE
Mailing Address - Street 2:BUILDING 9, SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:770-953-0080
Mailing Address - Fax:770-953-0031
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 9, SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-953-0080
Practice Address - Fax:770-953-0031
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2012-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAAPC002358101YM0800X
GALPC006895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health