Provider Demographics
NPI:1447484324
Name:BURROUGHS, DONALD ANTHONY (MA,LPC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ANTHONY
Last Name:BURROUGHS
Suffix:
Gender:M
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PECAN BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6064
Mailing Address - Country:US
Mailing Address - Phone:706-725-9255
Mailing Address - Fax:
Practice Address - Street 1:3720 MARS HILL RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1578
Practice Address - Country:US
Practice Address - Phone:706-725-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional