Provider Demographics
NPI:1689130049
Name:SAGE PSYCHOLOGICAL WELLNESS, PC
Entity Type:Organization
Organization Name:SAGE PSYCHOLOGICAL WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:CARSON
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:619-752-4450
Mailing Address - Street 1:11440 W BERNARDO CT STE 256
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1653
Mailing Address - Country:US
Mailing Address - Phone:619-752-4450
Mailing Address - Fax:
Practice Address - Street 1:11440 W BERNARDO CT STE 256
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1653
Practice Address - Country:US
Practice Address - Phone:619-752-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty