Wallace, Divier J

Wallace, Divier J is an individual health care provider with primary practice located at 400 Estudillo Ave Ste 100 , San Leandro CA 94577-4962. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Marriage & Family Therapist, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Counselor is his primary health care specialty. Wallace, Divier J can be contacted via phone (510) 924-0548.

Contact Information

Primary practice address
400 Estudillo Ave Ste 100 San Leandro CA 94577-4962
Phone: (510) 924-0548
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 61914 California
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1750674388
LBN Legal business name Wallace, Divier J
Credentials M.A./MFTI
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2011
Last updated Jun 17th, 2021 - about 5 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.

Request for update

Popular Providers