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

Jakeyla Wallace

Individual provider Clinical Social Worker · NPI 1487470795

Jakeyla Wallace is a Clinical Social Worker in Concord, North Carolina. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

920 Church St N
Concord, NC 28025-2927
Phone: (704) 403-4004
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1487470795
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 2, 2024
Last updated in NPPESDecember 2, 2024
Certification dateDecember 2, 2024
Mailing address6218 Ginkgo Ln, Charlotte, NC 28215-7146

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