Provider Demographics
NPI:1700927407
Name:BURRELL, CHRISTINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:BURRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:BURRELL TOWNSEND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2386 CLOWER ST
Mailing Address - Street 2:BLDG C, SUITE 100
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6134
Mailing Address - Country:US
Mailing Address - Phone:770-985-2050
Mailing Address - Fax:770-985-2050
Practice Address - Street 1:2386 CLOWER ST
Practice Address - Street 2:BLDG C, SUITE 100
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6134
Practice Address - Country:US
Practice Address - Phone:770-985-2050
Practice Address - Fax:770-985-2050
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0029581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA543676761AMedicaid
80BBFVVMedicare ID - Type Unspecified
GA543676761AMedicaid