Courtney Creal Wallace, LCSW, CADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3882 Issued in KY

Practice address

1432 S Shelby St
Louisville, KY 40217-1166

Phone

(502) 635-4538

Fax

(502) 635-4570

NPI assigned

Aug 6, 2013

Last updated

May 28, 2014By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Volunteers of America of Kentucky Inc

  • Addiction (Substance Use Disorder) Counselor
  • Louisville, KY
  • NPI 1316154008
  NPD (past)

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401235200000",
    "number": "1548692189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 S SHELBY ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171107",
            "telephone_number": "502-635-4538",
            "fax_number": "502-635-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1432 S SHELBY ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171166",
            "telephone_number": "502-635-4538",
            "fax_number": "502-635-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COURTNEY",
        "middle_name": "CREAL",
        "credential": "LCSW, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-06",
        "last_updated": "2014-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "1771",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wallace Therapy Inc
• Deborah Wallace-Graham, MA, BCBA, LBA
• Allen Keith Wallace Jr.
• Bennett Allan Wallace, M.S.S.W
• Carolyn Ann Wallace, LCADC
• Deborah I Wallace, M.D.
• Elizabeth Keller Wallace, MA, CFY-SLP
• Kali Wallace, APRN
• Kiara Learlene Wallace, MD
• Melissa Wallace

• Clinical Social Worker in Louisville, KY
• Providers in Louisville, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; 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.