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Organization
DR. ELIZABETH WISE LICENSED CLINICAL SOCIAL WORKER INC.
Active
Organization
DR. ELIZABETH WISE LICENSED CLINICAL SOCIAL WORKER INC.
Active
Other names
DR. ELIZABETH WISE LICENSED CLINICAL SOCIAL WORKER INC.
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH WISE LCSW, PSYD (OWNER, PSYCHOTHERAPIST)
(310) 422-2047
Entity
Organization
Contact information
Practice address
2500 CEDARWOOD DR., PINE MOUNTAIN CLUB, CA 93222
(310) 422-2047
Mailing address
PO BOX 6750, PINE MOUNTAIN CLUB, CA 93222-6750
(310) 422-2047
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255833125
—
CA
Enumeration date
09/09/2021
Last updated
09/09/2021
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