Provider Demographics
NPI:1144555186
Name:BURKE, SHELLEY LYNN (MA, LPC, QMHP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA, LPC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 JENNINGS MILL RD UNIT 3000B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7280
Mailing Address - Country:US
Mailing Address - Phone:706-389-8143
Mailing Address - Fax:
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 3000B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7280
Practice Address - Country:US
Practice Address - Phone:706-389-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3566101YP2500X
GALPC009914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional