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

Individual provider Clinical Social Worker · NPI 1528667060

Mr. Dustin Wade Wallace, LCSW is a Clinical Social Worker in Glendale, Arizona. Practices as a sole proprietor. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

4619 W Saguaro Dr
Glendale, AZ 85304-4424
Phone: (602) 999-3355
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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 · Licence LCSW-21756

Record details

NPI number1528667060
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorYes
NPI enumeratedOctober 24, 2020
Last updated in NPPESAugust 29, 2023
Certification dateAugust 29, 2023

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