Mijin Wall

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A15832 Issued in NC

Practice address

2620 W Main St
Albemarle, NC 28001-7457

Phone

(980) 581-8144

NPI assigned

Aug 13, 2020

Last updated

Aug 13, 2020By the provider in NPPES

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

Opted out of Medicare

Yes, effective Mar 19, 2024 through Mar 19, 2028

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Creative Counseling and Learning Solutions, PLLC

  • Professional Counselor
  • Albemarle, NC
  • NPI 1972842599
  NPD

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597276800000",
    "number": "1417568452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 W MAIN ST",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280017457",
            "telephone_number": "980-581-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 W MAIN ST",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280017457",
            "telephone_number": "980-581-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "MIJIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A15832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #19992)
• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #10619)
• Walgreen Co (Rite Aid)
• Charles Lynn Walker, PA
• Myles Jamar Wallace
• Shaw P Wan, MD
• Amy Parsons Ward
• Susan Carol Watson, M.D.
• Western Carolina Emergency Physicians, PLLC

• Professional Counselor in Albemarle, NC
• Providers in Albemarle, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; 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.

Verify at the official NPI Registry.