Provider Demographics
NPI:1477810984
Name:BURNS, DANIELLE NICOLE (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:NICOLE
Last Name:BURNS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:NICHOLE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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
Practice Address - Country:US
Practice Address - Phone:619-253-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2024-01-02
Deactivation Date:2022-04-06
Deactivation Code:
Reactivation Date:2022-06-22
Provider Licenses
StateLicense IDTaxonomies
CA809171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477810984OtherMEDICAL
CA1477810984Medicaid