Provider Demographics
NPI:1295471571
Name:DANIELLE NICOLE BURNS, LICENSED CLINICAL SOCIAL WORKER, INCORPORATED
Entity Type:Organization
Organization Name:DANIELLE NICOLE BURNS, LICENSED CLINICAL SOCIAL WORKER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MA, LCSW
Authorized Official - Phone:619-852-2335
Mailing Address - Street 1:1501 SAN ELIJO RD S # 104-310
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2047
Mailing Address - Country:US
Mailing Address - Phone:619-852-2335
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN ELIJO RD S # 104-310
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2047
Practice Address - Country:US
Practice Address - Phone:619-852-2335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty