Individual
DR. CHRISTY WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1104 CAMINO DEL MAR, SUITE 107, DEL MAR, CA 92014-2656
(877) 880-7337
(858) 923-1121
Mailing address
1104 CAMINO DEL MAR, 107, DEL MAR, CA 92014-2656
(877) 880-7337
(858) 923-1121
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY19841
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY19841
CA
103TF0200X
Forensic Psychologist
PSY19841
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11521017
CAQH
CA
Enumeration date
11/29/2005
Last updated
01/17/2012
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