Provider Demographics
NPI:1922303411
Name:BURKHARDT, GINA M (LMFT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:BURKHARDT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:BONGIORNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4510 EXECUTIVE DR STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3029
Mailing Address - Country:US
Mailing Address - Phone:619-952-8041
Mailing Address - Fax:858-534-6727
Practice Address - Street 1:4510 EXECUTIVE DR STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3029
Practice Address - Country:US
Practice Address - Phone:619-952-8041
Practice Address - Fax:858-534-6727
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78981106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist