Donielle R Wallace

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.2405894 Issued in OH

Practice address

2135 Dana Ave Ste 220
Cincinnati, OH 45207-1342

Phone

(216) 468-5000

NPI assigned

May 7, 2020

Last updated

Mar 10, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Psychological and Behavioral Consultants LLCGroup PAC ID 0446243760, 595 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Psychological & Behavioral Consultants, LLC

  dba LifeStance Health

  • Psychiatry Physician
  • Beachwood, OH
  • NPI 1811915713

  Clinical

  Medicare reassignment Care Compare group NPD
• L & P Services, Inc.

  • Public Health or Welfare Agency
  • Marietta, OH
  • NPI 1942289301

  Clinical

  NPD (past)
• Pfeifer Counseling, Consulting and Training LLC

  dba Pfeifer Therapeutics

  • Professional Counselor
  • Williamstown, WV
  • NPI 1841657749
  NPD (past)
• Westbrook Health Services, Inc.

  • Community/Behavioral Health Agency
  • Parkersburg, WV
  • NPI 1952357568
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1073135521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207D COLEGATE DR",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457502363",
            "telephone_number": "740-376-0930",
            "fax_number": "740-376-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2135 DANA AVE STE 220",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452071342",
            "telephone_number": "216-468-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "207D Colegate Dr",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "OH",
            "postal_code": "457502363",
            "country_code": "US",
            "telephone_number": "740-376-0930",
            "fax_number": "740-376-0933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DONIELLE",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-07",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "S.1904386",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2405894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Tobias Wallace, DMD
• Chasei Wallace
• Chiquita Wallace
• Christina Wallace
• Christine Wallace, MD
• Geri Wallace
• Jennifer Lynn Wallace, LPN
• John E Wallace, DPT
• Laurie A. Wallace, APRN
• Mallory Wallace

• Clinical Social Worker in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.