MEDICARE: MS. ADEOLA MAISHA SOULE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	97350	CA

General Provider Information

NPI Number	:	1386199131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADEOLA MAISHA SOULE LCSW

Provider Business Mailing Address
First Line	:	823 GATEWAY CENTER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4541
Country	:	US
Telephone Number	:	619-515-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 LANDIS AVE # 100
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-2627
Country	:	US
Telephone Number	:	619-906-5383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	10/09/2024

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