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General NPI Number Information
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NPI Number | 1346788833
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Entity Type | Individual
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Provider Name | SHAKINNA LUCILLE BURTON
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Gender | Female
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 02/06/2017
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Provider Practice Location Address
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Address Line | 1485 M 139
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City | BENTON HARBOR
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State | MI
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Zip | 49022-5711
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Country | US
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Telephone | 180-033-6034
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Fax |
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Provider Business Mailing Address
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Address Line | 1956 TERRITORIAL RD APT 6
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City | BENTON HARBOR
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State | MI
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Zip | 49022-8086
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Country | US
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Telephone | 269-934-1621
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | MI
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