Alexandria Wall, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904013036 Issued in VA

Practice address

350 Poplar Dr
Petersburg, VA 23805-9367

Phone

(804) 733-6874

NPI assigned

Jun 22, 2021

Last updated

Jun 22, 2021By the provider in NPPES

Sex

Female

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

Enrolled in VA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Mind Health Center LLCGroup PAC ID 8022429661, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Mind Health Center, LLC

  • Clinical Social Worker
  • Henrico, VA
  • NPI 1336699461
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624320000000",
    "number": "1790354074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 MOORMAN AVE",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238343130",
            "telephone_number": "804-896-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 POPLAR DR",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059367",
            "telephone_number": "804-733-6874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "ALEXANDRIA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904013036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Dalton Wagner, APRN
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2160)
• Wal-Mart Stores East, LP (Vision Center 30-2160)
• Walgreen Co (Walgreens #09270)
• Ebony Glynn Walker, LPC
• John Edward Wall, RPH
• Kelly Elizabeth Wallace, NP
• Walnut Hill Pharmacy Inc
• Martina Rochelle Washington, SURGICAL ASSISTANT
• Deborah J. Webb, CPHT

• Clinical Social Worker in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.