Victoria Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6772 Issued in LA

Practice address

112 Desirable Lane
Monroe, LA 71203

Phone

(318) 651-9866

NPI assigned

Aug 12, 2010

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

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Delta Human Services AuthorityGroup PAC ID 2961726005, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northeast Delta Human Services Authority

  dba Monroe Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Monroe, LA
  • NPI 1033551833
  Medicare reassignment Care Compare group NPD
• Northeast Delta Human Services Authority

  dba Winnsboro Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Winnsboro, LA
  • NPI 1578905386
  NPD
• Northeast Delta Human Services Authority

  dba Monroe Behavioral Health Child and Family Services - Medical

  • Primary Care Clinic/Center
  • Monroe, LA
  • NPI 1790158681
  NPD

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281571200000",
    "number": "1326353442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 DESIRABLE LANE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71203",
            "telephone_number": "318-651-9866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 DESIRABLE LANE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71203",
            "telephone_number": "318-651-9866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "VICTORIA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-12",
        "last_updated": "2010-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "6772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Wallace, COTA
• Latrenda Davis Wallace, MHS
• Paula M. Wallace, P.A.
• Suhan Wallace, M.A.
• Tara Ezell Wallace, OTA
• Walonda Shelise Wallace
• Crystal Wallingsford, CSW
• Walter M Sartor MD AMC
• Christie Harris Walters, WHNP
• Kristy Walters, RSW

• Clinical Social Worker in Monroe, LA
• Providers in Monroe, LA by specialty
• Clinical Social Worker in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.