| Doctor Name: | MR. THOMAS L DE WILDT |
| NPI Number: | 1124038500 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LCS 9390 |
| Business Practice Address: | 15525 Pomerado Rd Suite A-7 Poway, CA - 920642435 |
| Business Phone Number: | 8582791223 |
| Business Fax Number: | 8586738519 |
| Mailing Address: | 15525 Pomerado Rd, Suite A-7 POWAY |
| State: | CA |
| Postal Code: | 920642435 |
| Phone Number: | 8582791223 |
| Fax Number: | 8586738519 |
| NPI Enumeration Date: | 08/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS 9390 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |