Loretta Wallace
Counselor, Addiction (Substance Use Disorder) in New York, NY. Individual provider (NPI-1).
NPI number1932043957
StatusActive
Last updated in NPPESApr 18, 2026
Details
- NPI
- 1932043957
- Entity type
- Individual (NPI-1)
- Name
- Loretta Wallace
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 18, 2026
- Certification date
- Apr 18, 2026
- Last updated
- Apr 18, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 41880 | NY | Yes |
Practice location
60 E 112th St Apt 402New York, NY 10029-0314
Phone 646-245-7639
Mailing address
60 E 112th St Apt 402New York, NY 10029-0314
Phone 646-245-7639
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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