Wade M Falconburg, LCSW, MAC, PACT
Individual provider Active NPI Clinical Social Worker · Fairbanks, AK
NPI 1891994307 · NPPES record last updated Jan 1, 2025
Key facts
- NPI
- 1891994307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 223202 (AK)
- Practice address
- PO Box 61416
Fairbanks, AK 99706-1416 - Phone
- (208) 577-1015
- NPI assigned
- Jul 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ACADC-90 | ID | MD | Addiction (Substance Use Disorder) Counselor |
| 223202 | AK | MD | Clinical Social Worker |
| 28335 | ID | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sitman, Inc. | Multi-Specialty | Past | Accepting new patients |
| A to Z Family Services, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | ACADC-90 | ID | |
| Clinical Social Worker | 1041C0700X | 28335 | ID | |
| Clinical Social Worker |
1041C0700X | 223202 | AK | Yes |
Addresses
Primary practice location
PO Box 61416
Fairbanks, AK 99706-1416
Mailing address
PO Box 61416
Fairbanks, AK 99706-1416
Phone (208) 577-1015
Other providers in Fairbanks, AK
- Fairbanks Taxi Services LLC.
- Fairbanks Ultrasound, LLC.
- Fairbanks Urology
- Fairbanks Vascular Surgery
- Fairbanks Youth Advocates
- Lois Faller
- Family Centered Services of Ak
- Family Centered Services of Alaska
- Family Centered Services of Alaska
- Family Centered Services of Alaska
All providers in Fairbanks, AK · Clinical Social Worker in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.