Provider Demographics
NPI:1497291868
Name:WAHLIG, NANCY JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:WAHLIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13914 CAYUCOS CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4424
Mailing Address - Country:US
Mailing Address - Phone:858-688-2398
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE
Practice Address - Street 2:#803
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6906
Practice Address - Country:US
Practice Address - Phone:858-688-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS169591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical