Individual
HAZEL CARLOS WIESSE-PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
847 NE 19TH AVE, SUITE 100, PORTLAND, OR 97232-2684
(503) 238-0769
Mailing address
8690 AERO DR STE 115-260, SAN DIEGO, CA 92123-1886
(858) 837-6337
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
0
—
1041C0700X
Clinical Social Worker
Primary
L7660
OR
1041C0700X
Clinical Social Worker
Primary
—
CA
Other
Enumeration date
09/06/2012
Last updated
03/04/2026
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