Wallace, Roger A
Wallace, Roger A is an sole proprietor health care provider with primary practice located at 410 Mills Gap Rd. , Arden NC 28704. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Wallace, Roger A can be contacted via phone (828) 654-0111.Contact Information
Primary practice address
410 Mills Gap Rd.
Arden NC 28704
Phone: (828) 654-0111
Fax: (828) 654-0111
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 1179 | North Carolina |
Profile Details
| NPI number | 1053501783 |
|---|---|
| LBN Legal business name | Wallace, Roger A |
| Credentials | Master of Arts (MA) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 30th, 2007 |
| Last updated | Oct 16th, 2008 - about 18 years ago |
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 | 1053501783 | NPPES |
| North Carolina | MEDICAID | 6107178 |
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