Gregory Wallace is a Clinical in Columbia, Maryland. Gregory Wallace practices all healthcare services and medical treatments related to Clinical. The NPI Number for Gregory Wallace is 1700898012. The last update date is 2023-03-02.
Gregory Wallace's current location address is 6005 Camelback Ln, Columbia, Maryland. You can contact this provider via phone number 3018061892 and fax number 3014681862. The mailing address for Gregory Wallace is 6005 Camelback Ln, Columbia, Maryland. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Gregory Wallace |
|---|---|
| Address | 6005 Camelback Ln, Columbia, Maryland |
| Phone Number | 3018061892 |
| Fax Number | 3014681862 |
| Sole Proprietor | Y |
| Credentials | LCSWC |
NPI Number Detail
| NPI Number | 1700898012 |
|---|---|
| Provider Enumeration Date | 2006-08-13 |
| Last Updated Date | 2023-03-02 |
Provider Mailing Address Detail
| Address | 6005 Camelback Ln |
|---|---|
| City | Columbia |
| State | Maryland (MD) |
| Post Code | 210453810 |
| Phone Number | 3018061892 |
| Fax Number | 3014681862 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | 12531 |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 248050 | MD | KAISER | |
| 406695200 | MD | -- | |
| 64403601 | MD | BCBS OF MD | |
| 7383677 | MD | AETNA | |
| 724490000 | MD | MAGELLAN | |
| A2840144 | DC | BCBS OF DC |
Post Comment/ Review Below
What is the unique 10-digit identification code assigned to Gregory Wallace by the Centers for Medicare & Medicaid Services?
The Gregory Wallace has been issued the NPI (National Provider Identifier) 1700898012, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Gregory Wallace?
The Gregory Wallace is situated at 6005 Camelback Ln, in the city of Columbia, state of MD, with the zip code 210453810.
What is Gregory Wallace's specialized field of practice, and what is the corresponding taxonomy classification code?
The Gregory Wallace's area of specialization is Clinical, and the corresponding taxonomy code that categorizes this field of practice is 1041C0700X.
When did the Gregory Wallace receive its 1700898012?
The Gregory Wallace was issued its 1700898012 on 2006-08-13, which is the date when the organization was assigned this unique identifier.
When was the Gregory Wallace's information last updated?
The Gregory Wallace's information was last updated on 2023-03-02.
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