DIERDRE WALLACE
NPI 1205381787
Marriage & Family Therapist in Oakland, CA

Q: What is Dierdre Wallace's NPI number?

The NPI number for Dierdre Wallace is 1205381787. It was assigned to this individual provider in the NPPES registry on August 24, 2016.

Q: What is Dierdre Wallace's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: Is Dierdre Wallace enrolled in Medicare?

No. Dierdre Wallace has opted out of Medicare through January 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Dierdre Wallace was last updated on April 10, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 24, 2016Opted out of Medicare · through Jan 1, 2028

3800 COOLIDGE AVE, OAKLAND, CA 94602(510) 482-2244 Get Directions Write a Review

NPPES record last updated: April 10, 2018. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Apr 10, 2018, Aug 24, 2016 (2 updates tracked since 2016).

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About Dierdre Wallace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIERDRE WALLACE (NPI 1205381787) is an individual marriage & family therapist in Oakland, California and active in the NPI registry since August 2016. She has opted out of Medicare through January 1, 2028 and maintains a secondary practice location in Oakland.

NPPES Registry Identity

NPI1205381787

Entity TypeIndividualFemale

Primary Taxonomy106H00000X

Provider Legal NameDIERDRE WALLACE

Location Address3800 COOLIDGE AVEOakland, CA 94602-3311

Mailing Address2326 Fruitvale AveOakland, CA 94601-2534

Phone(510) 482-2244

Sole ProprietorNo

Enumeration DateAugust 24, 2016

Last NPPES UpdateApril 10, 20182 updates tracked since enumeration

✔ NPI 1205381787 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X

3800 COOLIDGE AVE, Oakland, CA 94602

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Secondary Practice Location 1

Location 12501 Harrison StOakland, CA 94612-3811 · Phone (510) 444-3344

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dierdre Wallace has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024

Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARY ELLEN ROJAS

Marriage & Family Therapist