Provider Demographics
NPI:1982141156
Name:BURCH, SHEVLENE WALKER (MS, LAPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SHEVLENE
Middle Name:WALKER
Last Name:BURCH
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WINDWARD HLS
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5991
Mailing Address - Country:US
Mailing Address - Phone:404-277-8316
Mailing Address - Fax:
Practice Address - Street 1:112 WINDWARD HLS
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5991
Practice Address - Country:US
Practice Address - Phone:404-277-8316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004669101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health