Healthcare Provider Details

I. General information

NPI: 1548620503
Provider Name (Legal Business Name): WELL AND SOUND CENTER FOR COUNSELING AND DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12396 WORLD TRADE DR STE 105
SAN DIEGO CA
92128-3787
US

IV. Provider business mailing address

12396 WORLD TRADE DR STE 105
SAN DIEGO CA
92128-3787
US

V. Phone/Fax

Practice location:
  • Phone: 858-224-2255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23378
License Number StateCA

VIII. Authorized Official

Name: PAULINE HSIEH
Title or Position: OWNER
Credential: PSYD
Phone: 858-224-2255