Organization
NEUROEVOLVE INTEGRATIVE HEALTH, A PROFESSIONAL PSYCHOLOGY CORPORATION
Active
Other names
NeuroEvolve Integrative Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMANTHA D WILSON PSYD, LCSW (CFO)
(760) 616-9311
Entity
Organization
Contact information
Practice address
10085 CARROLL CANYON RD STE 200H, SAN DIEGO, CA 92131-1100
(858) 208-3463
Mailing address
10085 CARROLL CANYON RD STE 200H, SAN DIEGO, CA 92131-1100
(858) 208-3463
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
06/12/2024
Last updated
11/06/2024
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