Active NPI
Dierdre Wallace
- Marriage & Family Therapist
- Oakland, CA
National Provider Identifier
1205381787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 3800 Coolidge Ave
Oakland, CA 94602-3311 - Phone
- (510) 482-2244
- NPI assigned
- Aug 24, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary | ||
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
3800 Coolidge Ave
Oakland, CA 94602-3311
Mailing address
2326 Fruitvale Ave
Oakland, CA 94601-2534
Other practice location 1
2501 Harrison St
Oakland, CA 94612-3811
Phone (510) 444-3344
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John F. Kennedy University | Mental Health | Past | Accepting new patients |
| Oakland Counseling Center | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Case Management Agency
- Oakland, CA
- NPI 1053956755
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523318400000",
"number": "1205381787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2326 FRUITVALE AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946012534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 COOLIDGE AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946023311",
"telephone_number": "510-482-2244"
}
],
"practiceLocations": [
{
"address_1": "2501 Harrison St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946123811",
"country_code": "US",
"telephone_number": "510-444-3344",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "DIERDRE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-24",
"last_updated": "2018-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.