Individual
DAVID WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
12470 FIORI LANE, SEBASTOPOL, CA 95472
(707) 874-2225
Mailing address
12470 FIORI LANE, SEBASTOPOL, CA 95472
(707) 874-2225
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY4050
CA
Other
Enumeration date
06/17/2009
Last updated
06/17/2009
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