Provider Demographics
NPI:1821756487
Name:BURRELL, D'ASIA
Entity Type:Individual
Prefix:
First Name:D'ASIA
Middle Name:
Last Name:BURRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 W BAGLEY RD STE 216
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1352
Mailing Address - Country:US
Mailing Address - Phone:216-340-0011
Mailing Address - Fax:
Practice Address - Street 1:24570 LAKE SHORE BLVD APT 108
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1232
Practice Address - Country:US
Practice Address - Phone:216-785-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health