Wallace Mental Health & Addiction Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WALLACE MENTAL HEALTH & ADDICTION COUNSELING LLC

Practice address

1810 Saddlewood PL
Bartow, FL 33830-2917

Phone

(863) 529-3725

NPI assigned

Aug 12, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Reginal A. Wallace, LCSWNPI 1205400066

Title

Licensed Clinician Social Worker

Phone

(863) 529-3725

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Reginal Arnett Wallace, LCSW

  • Clinical Social Worker
  • Winter Haven, FL
  • NPI 1205400066
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1660262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1730817149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 SADDLEWOOD PL",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338302917",
            "telephone_number": "863-529-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 SADDLEWOOD PL",
            "city": "BARTOW",
            "state": "FL",
            "postal_code": "338302917",
            "telephone_number": "863-529-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE MENTAL HEALTH & ADDICTION COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-12",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "REGINAL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "LICENSED CLINICIAN SOCIAL WORKER",
        "authorized_official_telephone_number": "863-529-3725",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP.
• Walgreen Co
• Carmen R Walker
• Kenya L Walker
• Kirby R. Walker
• Keith Walmsley, LMHC
• Kayla Wanamaker, RN
• Qasim Ward
• Lorenzo Wardell
• Watkins Adult Family Care Home

• Clinical Social Worker in Bartow, FL
• Providers in Bartow, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.