Provider Demographics
NPI:1912239773
Name:BURSON, SEDARA MAIA (LPC, CPCS, MAC)
Entity type:Individual
Prefix:MS
First Name:SEDARA
Middle Name:MAIA
Last Name:BURSON
Suffix:
Gender:F
Credentials:LPC, CPCS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 PRESTON VIEW CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7313
Mailing Address - Country:US
Mailing Address - Phone:404-913-6242
Mailing Address - Fax:
Practice Address - Street 1:457 JEFFERSON CHASE CIR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-2881
Practice Address - Country:US
Practice Address - Phone:513-470-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC00674OtherLICENSED PROFESSIONAL COUNSELOR