Chauncey Wallace, CDCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

050034 Issued in OH

Practice address

284 S State St
Marion, OH 43302-3940

Phone

(614) 832-7647

Fax

(740) 375-5583

NPI assigned

Nov 26, 2018

Sex

Male

Sole proprietor

No

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.

• Sean Phillips Recovery Center LLC

  • Addiction (Substance Use Disorder) Counselor
  • Loudonville, OH
  • NPI 1407553894
  NPD Authorized official

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

{
    "created_epoch": "1543190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1215407945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 S STATE ST",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433023940",
            "telephone_number": "614-832-7647",
            "fax_number": "740-375-5583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 S STATE ST",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433023940",
            "telephone_number": "614-832-7647",
            "fax_number": "740-375-5583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHAUNCEY",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-26",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "050034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve Walke
• Amanda Walker, PTA
• Carolina Walker, COTA
• Hannah Walker, LSW
• Tana Walker
• Heidi Rose Walter, MSW,LISW,LIDCD
• Peggy A. Walter, MA, PCC
• Ann Walters, D.M.D., M.S.
• Daniel Todd Ward
• Kristan Marie Warren, LISW

• Addiction (Substance Use Disorder) Counselor in Marion, OH
• Providers in Marion, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; 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.