Provider Demographics
NPI:1366077026
Name:BURKHALTER, PAUL (MS, MA, LAPC, NCC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:BURKHALTER
Suffix:
Gender:M
Credentials:MS, MA, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 AKERS MILL RD SE APT B12
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2500
Mailing Address - Country:US
Mailing Address - Phone:678-777-5582
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 1810
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7171
Practice Address - Country:US
Practice Address - Phone:877-752-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006860101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)