Provider Demographics
NPI:1154896785
Name:WONG, JAKE WEI HUNG (LCSW)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:WEI HUNG
Last Name:WONG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6244 EL CAJON BLVD STE 17
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3918
Mailing Address - Country:US
Mailing Address - Phone:619-287-8225
Mailing Address - Fax:619-393-0386
Practice Address - Street 1:1011 CAMINO DEL RIO S STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3567
Practice Address - Country:US
Practice Address - Phone:619-287-8225
Practice Address - Fax:619-393-0386
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW905171041C0700X, 1041C0700X
CALCSW1063501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical