Provider Demographics
NPI:1124508452
Name:BURCH, SHAKENYA (LPC, NCC, CPCS, ACS)
Entity type:Individual
Prefix:
First Name:SHAKENYA
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:LPC, NCC, CPCS, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 BOXELDER CV
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-8244
Mailing Address - Country:US
Mailing Address - Phone:678-587-8135
Mailing Address - Fax:678-585-6897
Practice Address - Street 1:3200 POINTE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3370
Practice Address - Country:US
Practice Address - Phone:678-259-9298
Practice Address - Fax:678-585-6897
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005453101YP2500X
GALPC011000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional