Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 36522 | TX |
NPI | 1104272491 |
---|---|
Provider Name | Dr. Christina Lynne Wise |
First Address | Dallas, TX 75229-5949 |
Second Address | Dallas, TX 75247-6923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2016 |
Last Update Date | 13/01/2022 |