Provider Demographics
NPI:1154734648
Name:BURROUGHS, KENYETTA RICHELLE (MA)
Entity type:Individual
Prefix:
First Name:KENYETTA
Middle Name:RICHELLE
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5634
Mailing Address - Country:US
Mailing Address - Phone:706-327-0279
Mailing Address - Fax:706-327-5294
Practice Address - Street 1:4411 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5634
Practice Address - Country:US
Practice Address - Phone:706-327-0279
Practice Address - Fax:706-327-5294
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)