Active NPI
Fallon Victoria Wall
- Mental Health Counselor
- Charlotte, NC
National Provider Identifier
1033636386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A12803
- Practice address
- 610 E 7TH St
Charlotte, NC 28202-2923 - Phone
- (980) 474-1716
- NPI assigned
- Aug 28, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A12803 | NC | Primary |
Addresses
Primary practice location
610 E 7TH St
Charlotte, NC 28202-2923
Mailing address
707 Regency Dr
Charlotte, NC 28211-5418
Phone (704) 591-2019
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A12803 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503878400000",
"number": "1033636386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 REGENCY DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282115418",
"telephone_number": "704-591-2019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 E 7TH ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282022923",
"telephone_number": "980-474-1716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "FALLON",
"middle_name": "VICTORIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-28",
"last_updated": "2017-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A12803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.