Provider Demographics
NPI:1659659878
Name:BURNS-MAYFIELD, DIANA PATRICE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PATRICE
Last Name:BURNS-MAYFIELD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EPPES ST
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2717
Mailing Address - Country:US
Mailing Address - Phone:804-541-1445
Mailing Address - Fax:
Practice Address - Street 1:4035 BAYWIND WALK NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7610
Practice Address - Country:US
Practice Address - Phone:504-236-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist