1. Home
  2. Directory
  3. New Mexico
  4. Farmington
  5. Counselor
  6. NPI Profile

CHARLES L WALLACE LADAC
NPI 1902140932
Counselor - Addiction (Substance Use Disorder) in Farmington, NM

Active since November 15, 2012
653 W ARRINGTON ST, FARMINGTON, NM 87401(505) 564-3733 Get Directions Write a Review

NPPES record last updated: May 22, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Charles L Wallace Ladac NPPES

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

CHARLES L WALLACE LADAC (NPI 1902140932) is an individual addiction (substance use disorder) provider in Farmington, New Mexico, licensed in New Mexico (3628) and active in the NPI registry since November 2012.

NPPES Registry Identity

NPI1902140932
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameCHARLES L WALLACECredential: LADAC
Location Address653 W ARRINGTON STFarmington, NM 87401-8513
Mailing Address653 W Arrington StFarmington, NM 87401-8513 · (505) 564-3733
Phone(505) 564-3733
Sole ProprietorNo
Enumeration DateNovember 15, 2012
Last NPPES UpdateMay 22, 2025
NPPES CertifiedMay 22, 2025
✔ NPI 1902140932 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
License✔ Licensed in NM · 3628
653 W ARRINGTON ST, Farmington, NM 87401
Open in Google Maps ↗

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.

V SAPPHIRE SUN HORT LADAC
Counselor (Addiction (Substance Use Disorder))
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733
JOHN ROGERS
Case Manager/Care Coordinator
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733
CHAD ROPER CPSW
Peer Specialist
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733
DESMOND DUTREMAINE CPSW
Peer Specialist
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733
JOYCE VAUGHN
Peer Specialist
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733
MICHAEL IRVIN ASHLEY CPSW
Peer Specialist
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733
JOHN WALSH IV CSW
Peer Specialist
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733
JUSTIN BRADY CSW
Peer Specialist
653 W ARRINGTON ST
FARMINGTON, NM 87401
San Juan County (505) 564-3733

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 1902140932. It was assigned to this individual provider in the NPPES registry on November 15, 2012.

Where is Charles Wallace located?

Charles Wallace practices at 653 W Arrington St, Farmington, NM 87401. The listed phone number is (505) 564-3733.

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 May 22, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.