Healthcare Provider Details

I. General information

NPI: 1043441033
Provider Name (Legal Business Name): HELENA B WADE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HELENA B POMA LCSW, ASW

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 10/28/2021
Certification Date: 10/19/2021
Deactivation Date: 02/18/2020
Reactivation Date: 02/26/2020

III. Provider practice location address

4700 SPRING ST
LA MESA CA
91942
US

IV. Provider business mailing address

4700 SPRING ST STE 203
LA MESA CA
91942-0273
US

V. Phone/Fax

Practice location:
  • Phone: 619-591-5740
  • Fax:
Mailing address:
  • Phone: 619-549-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number85118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: