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General NPI Number Information
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NPI Number | 1649845918
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Entity Type | Individual
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Provider Name | HAILE MARIE WRIGHT LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 9500 GILMAN DR DEPT 304
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City | LA JOLLA
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State | CA
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Zip | 92093-0304
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Country | US
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Telephone | 858-534-3755
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 151525
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City | SAN DIEGO
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State | CA
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Zip | 92175-1525
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Country | US
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Telephone | 209-627-6926
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 100717
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License Number State | CA
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