Provider Demographics
NPI:1649350489
Name:BURRIS, DONNA E (LCSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:BURRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DANAWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-9146
Mailing Address - Country:US
Mailing Address - Phone:601-415-2060
Mailing Address - Fax:
Practice Address - Street 1:105 NORTHGATE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-9162
Practice Address - Country:US
Practice Address - Phone:601-442-7141
Practice Address - Fax:601-442-7343
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC23071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical