Healthcare Provider Details

I. General information

NPI: 1629932363
Provider Name (Legal Business Name): KIMBERLY DAWN BURTON LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 GA HIGHWAY 33 S
MOULTRIE GA
31788-2016
US

IV. Provider business mailing address

1814 GA HIGHWAY 33 S
MOULTRIE GA
31788-2016
US

V. Phone/Fax

Practice location:
  • Phone: 229-891-5223
  • Fax:
Mailing address:
  • Phone: 229-891-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC008768
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: