Formecia Wallace, MS, MA, LCAS-A

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

25169 Issued in NC

Practice address

618 E Boulevard
Williamston, NC 27892-2736

Phone

(252) 792-0659

Fax

(252) 792-0660

NPI assigned

Feb 20, 2019

Last updated

Mar 5, 2019By the provider in NPPES

Sex

Female

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

Credentials

Master of Arts, Master of Science

Practice roles

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.

• Milestone Innovative Services

  • Community/Behavioral Health Agency
  • Williamston, NC
  • NPI 1295271039

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551744000000",
    "number": "1518423045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 WYNN RD",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "278928844",
            "telephone_number": "252-864-6835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 E BOULEVARD",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "278922736",
            "telephone_number": "252-792-0659",
            "fax_number": "252-792-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "FORMECIA",
        "credential": "MS, MA, LCAS-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-20",
        "last_updated": "2019-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "25169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vital Point Health Resources
• Wal-Mart Stores East LP (Walmart Pharmacy 10-1641)
• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens # 17331)
• Brooke Wallace
• Karen C Ward, CRT, RCP
• Kristin Ward Warren, PA-C
• Waterside Therapy Associates, P.L.L.C.
• Kortney Shakia Watford
• Latasha Weeks, PHARM.D.

• Addiction (Substance Use Disorder) Counselor in Williamston, NC
• Providers in Williamston, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; 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.