Healthcare Provider Details

I. General information

NPI: 1003505736
Provider Name (Legal Business Name): JAMIE CHRISTINE WADE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE WADE GRIFFIN LCSW

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 W WASHINGTON BLVD STE 234
LOS ANGELES CA
90066-8128
US

IV. Provider business mailing address

2489 GLENCOE AVE
VENICE CA
90291-5002
US

V. Phone/Fax

Practice location:
  • Phone: 720-282-0741
  • Fax:
Mailing address:
  • Phone: 310-804-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931623
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: