Individual provider · Type 1 NPI

Divier J. Wallace, M.A./MFTI

Counselor · San Leandro, CA

NPI number 1750674388 Active

Practice location

400 Estudillo Ave Ste 100
San Leandro, CA 94577-4962

Call (510) 924-0548 Map

Specialties and licenses

TaxonomyCodeLicense
Case Manager/Care Coordinator 171M00000XNone listed
Marriage & Family Therapist 106H00000X61914 (CA)
Counselor Primary 101Y00000XNone listed

Counselor: A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

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About NPI 1750674388

Divier J. Wallace, M.A./MFTI's National Provider Identifier is 1750674388, issued on May 16, 2011. The primary taxonomy on file is Counselor (101Y00000X), and the practice location is in San Leandro, CA. The record was last updated on Jun 17, 2021.