Wallace, Gregory
Wallace, Gregory is an sole proprietor health care provider with primary practice located at 932 Hungerford Dr Ste 18B , Rockville MD 20850-1751. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Social Worker, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Wallace, Gregory can be contacted via phone (301) 806-1892.Contact Information
Primary practice address
932 Hungerford Dr Ste 18B
Rockville MD 20850-1751
Phone: (301) 806-1892
Fax: (301) 468-1862
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | 12531 | Maryland |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 12531 | Maryland |
Profile Details
| NPI number | 1700898012 |
|---|---|
| LBN Legal business name | Wallace, Gregory |
| Credentials | LCSWC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 13th, 2006 |
| Last updated | Mar 2nd, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700898012 | NPPES |
| Maryland | Other | 248050 | KAISER |
| Maryland | MEDICAID | 406695200 | KAISER |
| Maryland | Other | 64403601 | KAISER |
| Maryland | Other | 7383677 | KAISER |
| Maryland | Other | 724490000 | KAISER |
| Maryland | Other | A2840144 | KAISER |
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