Healthcare Provider Details

I. General information

NPI: 1336079201
Provider Name (Legal Business Name): HEATHER BURDINE LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5042 SKYLARK DR
HUNTINGTON BEACH CA
92649-1424
US

IV. Provider business mailing address

5042 SKYLARK DR
HUNTINGTON BEACH CA
92649-1424
US

V. Phone/Fax

Practice location:
  • Phone: 714-409-2204
  • Fax:
Mailing address:
  • Phone: 714-409-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. HEATHER BURDINE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 714-409-2204