Shelvey Jean Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C010042 Issued in NC

Practice address

5306 NC Highway 55 Ste 105
Durham, NC 27713-7812

Phone

(919) 457-1517

Fax

(919) 363-7697

NPI assigned

Dec 13, 2012

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Daymark Recovery Services, Inc.

  • Multi-Specialty Clinic/Center
  • Concord, NC
  • NPI 1558329243

  Clinical

  NPD
• Kristin McArthur, MD, PLLC

  • Geriatric Psychiatry Physician
  • Cary, NC
  • NPI 1801398805
  NPD
• Monarch

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1073267126
  NPD
• Monarch

  • Community/Behavioral Health Agency
  • Albemarle, NC
  • NPI 1801116405
  NPD
• Monarch

  • Community/Behavioral Health Agency
  • Albemarle, NC
  • NPI 1972644334
  NPD
• October Road Inc

  • Community/Behavioral Health Agency
  • Jacksonville, NC
  • NPI 1376389940
  NPD
• October Road Inc.

  • Community/Behavioral Health Agency
  • Asheville, NC
  • NPI 1144375767

  Addiction (Substance Use Disorder)

  NPD
• Rha Behavioral Health NC LLC

  • Community/Behavioral Health Agency
  • Asheville, NC
  • NPI 1164151080
  NPD
• Rha Behavioral Health NC LLC

  • Community/Behavioral Health Agency
  • Burlington, NC
  • NPI 1548620297
  NPD
• Rha Behavioral Health NC LLC

  • Community/Behavioral Health Agency
  • Whiteville, NC
  • NPI 1700318680
  NPD
• Senior Health and Education Partners PLLC

  • Psychiatry Physician
  • Durham, NC
  • NPI 1205237245
  NPD
• BMSC NC LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1831611649
  NPD

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

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1588900989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5306 NC HIGHWAY 55 STE 105",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277137812",
            "telephone_number": "919-457-1517",
            "fax_number": "919-363-7697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5306 NC HIGHWAY 55 STE 105",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277137812",
            "telephone_number": "919-457-1517",
            "fax_number": "919-363-7697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "284 Executive Park Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280251833",
            "country_code": "US",
            "telephone_number": "704-939-1100",
            "fax_number": "704-939-1173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHELVEY",
        "middle_name": "JEAN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-13",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-21629",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C010042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isaac Galen Wallace, LMBT
• Kayla J Wallace
• Lauren Rose Wallace, MSW, LCSWA
• Roberta Wallace
• Scott Arthur Wallace, PA-C
• Stephen Russell Wallace, DO
• Todd A Wallace, PA-C
• Stacey Greanias Wallen, CGC
• Ethan Waller, RD, LDN
• Jesscia Wallis

• Clinical Social Worker in Durham, NC
• Providers in Durham, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.