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General NPI Number Information
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NPI Number | 1881943405
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Entity Type | Individual
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Provider Name | JAMILLAH WALIDAH PARGO-THOMPSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 1255 E VISTA WAY STE 221
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City | VISTA
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State | CA
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Zip | 92084-4039
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Country | US
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Telephone | 442-322-7042
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Fax | 760-254-8594
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Provider Business Mailing Address
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Address Line | 1255 E VISTA WAY STE 221
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City | VISTA
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State | CA
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Zip | 92084-4039
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Country | US
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Telephone | 442-322-7042
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Fax | 760-254-8594
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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 | LCSW77401
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License Number State | CA
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