Provider Demographics
NPI:1467817031
Name:BURCH, ADRIANA LOUISE-NEVIN (LMFT 115896)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:LOUISE-NEVIN
Last Name:BURCH
Suffix:
Gender:F
Credentials:LMFT 115896
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MORENA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3844
Mailing Address - Country:US
Mailing Address - Phone:619-276-8112
Mailing Address - Fax:
Practice Address - Street 1:1202 MORENA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3844
Practice Address - Country:US
Practice Address - Phone:619-276-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT115896106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist