Active NPI
Melissa Sue Wallace, SUDCC
- Addiction (Substance Use Disorder) Counselor
- Fresno, CA
National Provider Identifier
1881189181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 9478
- Practice address
- 2445 W Whites Bridge Ave
Fresno, CA 93706-1225 - Phone
- (559) 492-1373
- NPI assigned
- Jun 28, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 9478 | CA | Primary |
Addresses
Primary practice location
2445 W Whites Bridge Ave
Fresno, CA 93706-1225
Mailing address
2445 W Whites Bridge Ave
Fresno, CA 93706-1225
Phone (559) 264-5096
Other practice location 1
823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300
Other practice location 2
3575 Pershing Ave
San Diego, CA 92104-3413
Phone (161) 929-4452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Entra Casa Corporation | Past | Accepting new patients | |
| Comprehensive Addiction Programs Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Substance Abuse Rehabilitation Facility
- Fresno, CA
- NPI 1720221443
-
- Substance Abuse Rehabilitation Facility
- San Diego, CA
- NPI 1114411386
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663286400000",
"number": "1881189181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2445 W WHITES BRIDGE AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937061225",
"telephone_number": "559-264-5096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2445 W WHITES BRIDGE AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937061225",
"telephone_number": "559-492-1373"
}
],
"practiceLocations": [
{
"address_1": "823 Gateway Center Way",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921024541",
"country_code": "US",
"telephone_number": "619-515-2300",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3575 Pershing Ave",
"address_purpose": "LOCATION",
"city": "San Diego",
"state": "CA",
"postal_code": "921043413",
"country_code": "US",
"telephone_number": "161-929-4452",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "MELISSA",
"middle_name": "SUE",
"credential": "SUDCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-28",
"last_updated": "2022-09-16",
"certification_date": "2022-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "9478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.