Provider Demographics
NPI:1952601502
Name:BURTON, CHRISTOPHER KENN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KENN
Last Name:BURTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 HICKORY ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2312
Mailing Address - Country:US
Mailing Address - Phone:706-270-5003
Mailing Address - Fax:
Practice Address - Street 1:43 CHATEAU CT SE
Practice Address - Street 2:SE
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-7238
Practice Address - Country:US
Practice Address - Phone:706-233-9023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2034OtherLICENSE