Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ayesha Wallace

Individual provider Clinical Social Worker · NPI 1649522400

Ayesha Wallace is a Clinical Social Worker in Los Angeles, California. Licensed in California. Registered with an NPI since 2012.

Licensed in
CA
In the registry since
2012

Practice location Address checks out

710 E 111th Pl
Los Angeles, CA 90059-1518
Phone: (323) 233-0425
Fax: (323) 232-2366
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 79411 (CA)

Record details

NPI number1649522400
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 3, 2012
Last updated in NPPESSeptember 27, 2017

Other providers in Los Angeles