Provider Demographics
NPI:1881232668
Name:BURTON, ZATASCHA CYMONE (LPC)
Entity Type:Individual
Prefix:
First Name:ZATASCHA
Middle Name:CYMONE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 ALTA TOWNE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-5039
Mailing Address - Country:US
Mailing Address - Phone:803-917-7304
Mailing Address - Fax:
Practice Address - Street 1:2308 ALTA TOWNE LAKE CIR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-5039
Practice Address - Country:US
Practice Address - Phone:803-917-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health