Senetra Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C008919 Issued in NC

Practice address

4909 Waters Edge Dr
107
Raleigh, NC 27606-2462

Phone

(919) 247-9534

Fax

(919) 467-4219

NPI assigned

Nov 11, 2011

Last updated

Mar 3, 2015By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1320969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425340800000",
    "number": "1992082416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52271",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277172271",
            "telephone_number": "919-247-9534",
            "fax_number": "919-467-4219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 WATERS EDGE DR",
            "address_2": "107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276062462",
            "telephone_number": "919-247-9534",
            "fax_number": "919-467-4219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SENETRA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-11",
        "last_updated": "2015-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C008919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Anne Wallace, LCMHCA
• Kaitlyn D Wallace, PT
• Kathryn Paige Wallace, CCC-SLP
• Nicole Janeen Wallace, LCMHC
• Sarah Wallace
• David Wallach
• Andrea Wallenbeck
• Luke Allan Wallenbeck
• Kimberly B Waller, MA, LPC
• Rebecca Irene Walls, OTR/L

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2015; 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.