What is Divier Wallace's NPI number?

The NPI number assigned to this healthcare provider is 1750674388, enumerated as a individual on May 16, 2011.

Where is the provider located?

The provider is located at 400 ESTUDILLO AVE STE 100 SAN LEANDRO, CA 94577 and the phone number is (510) 924-0548.

What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101Y00000X.

MR. DIVIER J WALLACE M.A./MFTI - NPI 1750674388

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About Mr. Divier J Wallace M.a./mfti NPPES

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

MR. DIVIER J WALLACE M.A./MFTI (NPI 1750674388) is an individual counselor in San Leandro, California and active in the NPI registry since May 2011.

NPPES Registry Identity

NPI1750674388

Entity TypeIndividualMale

Primary Taxonomy101Y00000X

Provider Legal NameMR. DIVIER J WALLACECredential: M.A./MFTI

Location Address400 ESTUDILLO AVE STE 100San Leandro, CA 94577-4962

Mailing Address400 Estudillo Ave Ste 100San Leandro, CA 94577-4962 · (510) 924-0548

Phone(510) 924-0548

Sole ProprietorNo

Enumeration DateMay 16, 2011

Last NPPES UpdateJune 17, 2021

NPPES CertifiedJune 17, 2021

✔ NPI 1750674388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

Also ListedMarriage & Family TherapistTaxonomy 106H00000X · License 61914 (CA)

Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X

400 ESTUDILLO AVE STE 100, San Leandro, CA 94577

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