Christopher Scott Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22821 Issued in AZ

Practice address

101 N 1St Ave Ste 2325
Phoenix, AZ 85003-1933

Phone

(480) 569-1604

NPI assigned

Mar 28, 2017

Last updated

Apr 5, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743811200000",
    "number": "1366974610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N 1ST AVE STE 2325",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850031933",
            "telephone_number": "770-714-9847",
            "fax_number": "757-953-6091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N 1ST AVE STE 2325",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850031933",
            "telephone_number": "480-569-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHRISTOPHER",
        "middle_name": "SCOTT",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2025-04-05",
        "certification_date": "2025-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "17443",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904009872",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "22821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria M Wall
• Wallace Andrews LLC (Wallace Andrews)
• Annisha Wallace, LCSW
• Blake Taylor Wallace, DPM
• Cheryl Wallace, RDH
• David Warner Wallace, MD
• Donna C Wallace, PNP
• Evelyn J Wallace, RN
• Hattie Wallace
• John Wallace, M.D.

• Clinical Social Worker in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2025; 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.