Provider Demographics
NPI:1356168173
Name:BURTON, HARRISON LORENZO SR (RADT)
Entity type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:LORENZO
Last Name:BURTON
Suffix:SR
Gender:
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 EUCLID AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3611
Mailing Address - Country:US
Mailing Address - Phone:619-859-6270
Mailing Address - Fax:619-527-8536
Practice Address - Street 1:286 EUCLID AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3611
Practice Address - Country:US
Practice Address - Phone:619-859-6270
Practice Address - Fax:619-527-8536
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
CAR1546350124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist