Basic Information
| Provider Information | |||||||||
| NPI: | 1700232766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURCHETT | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | ANNA-MARIE | ||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615C KNIGHT RD NE | ||||||||
| Address2: | |||||||||
| City: | RANGER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307346717 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2615 CLEVELAND HWY | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307218160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062705040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.