Provider Demographics
NPI:1730400748
Name:BURKE, DIANA FRANCES (LPC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:FRANCES
Last Name:BURKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 S MILLEDGE AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5664
Mailing Address - Country:US
Mailing Address - Phone:706-410-5786
Mailing Address - Fax:
Practice Address - Street 1:337 S MILLEDGE AVE STE 216
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-5664
Practice Address - Country:US
Practice Address - Phone:706-410-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA896450Medicaid