Debora Wallace-Wood, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C1500049 Issued in OH

Practice address

1430 S High St
Columbus, OH 43207-1045

Phone

(614) 324-5479

NPI assigned

Aug 17, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Reach Back Corporation

  • Mental Health Counselor
  • Reynoldsburg, OH
  • NPI 1598690729
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1104371319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 S HIGH ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071045",
            "telephone_number": "614-324-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 S HIGH ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432071045",
            "telephone_number": "614-324-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-WOOD",
        "first_name": "DEBORA",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-17",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "C1500049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jody Lee Wall, PA-C
• Kimberly A Wall, LSW
• Patricia Wall
• Patrick M Wall, M.D.
• Sarah Allison Wall, MD
• Alan William Wallace, ATC, CSCS, PES
• Andrew Wallace, QMHS CMS
• Antone Wallace, MSW, LSW
• Benjamin Wallace, DO
• Bernice Lyntricia Wallace, LPN

• Professional Counselor in Columbus, OH
• Providers in Columbus, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.