Provider Demographics
NPI:1235953092
Name:BURDICK, KRISTINA ERIN (RADT-1)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ERIN
Last Name:BURDICK
Suffix:
Gender:F
Credentials:RADT-1
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:ERIN
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5941
Mailing Address - Country:US
Mailing Address - Phone:714-780-1174
Mailing Address - Fax:
Practice Address - Street 1:1320 W PEARL ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5941
Practice Address - Country:US
Practice Address - Phone:714-780-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1484090922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)