Provider Demographics
NPI:1093023160
Name:BURNSIDE, DANNY SR (MDIV, MA PH D)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:
Last Name:BURNSIDE
Suffix:SR
Gender:M
Credentials:MDIV, MA PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HEATHER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5939
Mailing Address - Country:US
Mailing Address - Phone:864-266-2291
Mailing Address - Fax:
Practice Address - Street 1:272 HEATHER GLEN DR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5939
Practice Address - Country:US
Practice Address - Phone:864-266-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional