Active NPI
Mack William Tolle
- Addiction (Substance Use Disorder) Counselor
- Victorville, CA
National Provider Identifier
1477073377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 1913097
- Practice address
- 15480 Ramona Ave
Victorville, CA 92392-2421 - Phone
- (760) 243-8252
- Fax
- (760) 245-3676
- NPI assigned
- Jun 21, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1913097 | CA | Primary |
Addresses
Primary practice location
15480 Ramona Ave
Victorville, CA 92392-2421
Mailing address
15480 Ramona Ave
Victorville, CA 92392-2421
Phone (760) 243-8252
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1913097 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Social Model Recovery Systems, Inc. | Past | Accepting new patients | |
| Social Model Recovery Systems, Inc. | 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.
-
- Community/Behavioral Health Agency
- Covina, CA
- NPI 1497834089
-
- Community/Behavioral Health Agency
- Covina, CA
- NPI 1508994369
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763596800000",
"number": "1477073377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15480 RAMONA AVE",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923922421",
"telephone_number": "760-243-8252",
"fax_number": "760-245-3676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15480 RAMONA AVE",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923922421",
"telephone_number": "760-243-8252",
"fax_number": "760-245-3676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOLLE",
"first_name": "MACK",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-21",
"last_updated": "2025-11-20",
"certification_date": "2025-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "1913097",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.