Sommer Sade' Wallace, M. Div
Student in an Organized Health Care Education/Training Program in San Diego, CA. Individual provider (NPI-1).
NPI number1083267751
StatusActive
Last updated in NPPESSep 8, 2025
Details
- NPI
- 1083267751
- Entity type
- Individual (NPI-1)
- Name
- Ms. Sommer Sade' Wallace
- Credential
- M. Div
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 22, 2019
- Certification date
- Sep 8, 2025
- Last updated
- Sep 8, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 101Y00000X | Counselor | – | – | |
| 171M00000X | Case Manager/Care Coordinator | – | – | |
| 225400000X | Rehabilitation Practitioner | – | – |
Practice location
3491 Kurtz St Ste 150San Diego, CA 92110-4430
Phone 619-320-2404
Mailing address
3491 Kurtz St Ste 150San Diego, CA 92110-4430
Phone 980-200-7138
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