Courtney Creal Wallace, LCSW, CADC is a
Social Worker - Clinical based in Louisville, Kentucky. Courtney Creal Wallace is licensed to practice in Kentucky (license number 3882) and her current practice location is
1432 S Shelby St, Louisville, Kentucky. She can be reached at her office (for appointments etc.) via phone at
(502) 635-4538.
NPI number for Courtney Creal Wallace is 1548692189 and her current mailing address is 1436 S Shelby St, Louisville, Kentucky. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1548692189.
Healthcare Provider's Profile
| Full Name | Courtney Creal Wallace |
|---|
| Gender | Female |
|---|
| Speciality | Social Worker - Clinical |
|---|
| Location | 1432 S Shelby St, Louisville, Kentucky |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1548692189
- Provider Enumeration Date: 08/06/2013
- Last Update Date: 05/28/2014
Medical Identifiers
Medical identifiers for Courtney Creal Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1548692189 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1771 (Kentucky) | Secondary |
| 1041C0700X | Social Worker - Clinical | 3882 (Kentucky) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Courtney Creal Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Courtney Creal Wallace, LCSW, CADC
1436 S Shelby St,
Louisville, KY 40217-1107
Ph: (502) 635-4538 | Courtney Creal Wallace, LCSW, CADC
1432 S Shelby St,
Louisville, KY 40217-1166
Ph: (502) 635-4538 |
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