Healthcare Provider Details

I. General information

NPI: 1609288968
Provider Name (Legal Business Name): JEANINE E. BURMEISTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E TRINITY PL
DECATUR GA
30030-3302
US

IV. Provider business mailing address

9 RAKESTRAW ST
NORCROSS GA
30071-2130
US

V. Phone/Fax

Practice location:
  • Phone: 404-378-2300
  • Fax:
Mailing address:
  • Phone: 313-330-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007801
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: