Sylvester Darren Wallace, LMSW, ACSW, C-ASWCM

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

MSW002075 Issued in GA

Practice address

3701 Loop Rd
Social Work Service 122
Tuscaloosa, AL 35404-5015

Phone

(205) 554-2000

Fax

(205) 554-3556

NPI assigned

Aug 30, 2006

Sex

Male

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629187976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7651 HIGHWAY 69 NORTH",
            "address_2": "APT 815",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354737862",
            "telephone_number": "205-339-6098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 LOOP RD",
            "address_2": "SOCIAL WORK SERVICE 122",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354045015",
            "telephone_number": "205-554-2000",
            "fax_number": "205-554-3556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SYLVESTER",
        "middle_name": "DARREN",
        "name_prefix": "Mr.",
        "credential": "LMSW, ACSW, C-ASWCM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "MSW002075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Walker
• Johnna Junkin Walker, CRNA
• Octavia Mechelle Breazeale Walker, RN
• Paul Walker, PHARM.D.
• Joseph Claude Wallace, M.D.
• William Robert Wallace, MD
• Valerie Walters, LGSW
• Preston Rosario Walthour
• Eddie Ling-Tse Wang, M.D.
• L Charles Ward, PH.D.

• Clinical Social Worker in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.