Provider Demographics
NPI:1336388024
Name:BURNHAM, WARREN W (LMSW, DMIN)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:W
Last Name:BURNHAM
Suffix:
Gender:M
Credentials:LMSW, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 WHEELER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6549
Mailing Address - Country:US
Mailing Address - Phone:706-855-0563
Mailing Address - Fax:706-855-0924
Practice Address - Street 1:3633 WHEELER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6549
Practice Address - Country:US
Practice Address - Phone:706-855-0563
Practice Address - Fax:706-855-0924
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW000689101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor