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CHARLES JEROME WALLACE CASAC-T
NPI 1780125203
Counselor - Addiction (Substance Use Disorder) in New York, NY

Active since March 16, 2017
55 W 125TH ST FL 11, NEW YORK, NY 10027(212) 864-4128(212) 662-9193 Get Directions Write a Review

NPPES record last updated: March 16, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Charles Jerome Wallace Casac-t NPPES

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

CHARLES JEROME WALLACE CASAC-T (NPI 1780125203) is an individual addiction (substance use disorder) provider in New York, New York and active in the NPI registry since March 2017.

NPPES Registry Identity

NPI1780125203
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameCHARLES JEROME WALLACECredential: CASAC-T
Location Address55 W 125TH ST FL 11New York, NY 10027-4516
Mailing Address55 W 125th St Fl 11New York, NY 10027-4516 · (212) 864-4128 · Fax (212) 662-9193
Phone(212) 864-4128
Fax(212) 662-9193
Sole ProprietorYes
Enumeration DateMarch 16, 2017
✔ NPI 1780125203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
55 W 125TH ST FL 11, New York, NY 10027
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Other Providers at the Same Location NPPES 8

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

TIMOTHY BECKMAN CASAC-T
Counselor (Addiction (Substance Use Disorder))
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128
MICHELLE KIM
Counselor
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128
ABDUL-RAHMAN WASHINGTON
Counselor (Addiction (Substance Use Disorder))
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128
SAMANTHA NOVEIHED
Counselor (Addiction (Substance Use Disorder))
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128
TONYA WHITENING LMSW
Social Worker
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128
ALEXANDER DOUGLAS FERDINANDI LMHC
Counselor (Mental Health)
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128
STEPHANY RODRIGUEZ
Counselor (Addiction (Substance Use Disorder))
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128
THOMAS WARD
Counselor (Addiction (Substance Use Disorder))
55 W 125TH ST FL 11
NEW YORK, NY 10027
New York County (212) 864-4128

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charles Wallace's NPI number?

The NPI number for Charles Wallace is 1780125203. It was assigned to this individual provider in the NPPES registry on March 16, 2017.

Where is Charles Wallace located?

Charles Wallace practices at 55 W 125th St Fl 11, New York, NY 10027. The listed phone number is (212) 864-4128.

What is Charles Wallace's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Charles Wallace was last updated on March 16, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.