Provider Demographics
NPI:1871075614
Name:BURROWES, DESHELLE RESHUN (APC)
Entity type:Individual
Prefix:MRS
First Name:DESHELLE
Middle Name:RESHUN
Last Name:BURROWES
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E ATLANTA RD STE B200
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3448
Mailing Address - Country:US
Mailing Address - Phone:770-871-1712
Mailing Address - Fax:
Practice Address - Street 1:320 LANIER AVE W STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7443
Practice Address - Country:US
Practice Address - Phone:770-871-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health