Provider Demographics
NPI:1740828300
Name:BURNS, LATEELA J (LPC)
Entity type:Individual
Prefix:
First Name:LATEELA
Middle Name:J
Last Name:BURNS
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 1:2151 PEACHFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6534
Mailing Address - Country:US
Mailing Address - Phone:770-455-3200
Mailing Address - Fax:678-301-5423
Practice Address - Street 1:3622 MEADOWGLENN VILLAGE LN APT H
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-5624
Practice Address - Country:US
Practice Address - Phone:404-532-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health