Provider Demographics
NPI:1154152767
Name:BURCH, JUANETTA ANDREA LATREECE (C-CHW)
Entity type:Individual
Prefix:
First Name:JUANETTA
Middle Name:ANDREA LATREECE
Last Name:BURCH
Suffix:
Gender:F
Credentials:C-CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 CABOT COVE DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9025
Mailing Address - Country:US
Mailing Address - Phone:740-739-8595
Mailing Address - Fax:
Practice Address - Street 1:5665 CABOT COVE DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9025
Practice Address - Country:US
Practice Address - Phone:740-739-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health