Kimberly Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008384 Issued in GA

Practice address

2852 Johnson Ferry Rd Ste 100
Marietta, GA 30062-5686

Phone

(404) 906-9831

NPI assigned

Apr 29, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Kimberly Wallace LPC LLC

  • Professional Counselor
  • Marietta, GA
  • NPI 1659987238
  Medicare reassignment NPD Authorized official
• Eagle'S Landing Christian Counseling Center, Inc.

  • Professional Counselor
  • McDonough, GA
  • NPI 1093955205
  NPD (past)

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700784000000",
    "number": "1083091987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2852 JOHNSON FERRY RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625686",
            "telephone_number": "404-906-9831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2852 JOHNSON FERRY RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625686",
            "telephone_number": "404-906-9831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KIMBERLY",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-29",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanesha Danielle Walker, LPC
• Tashianna Walker, COA
• Caprinxia Wallace
• Dawn M.L. Wallace
• Julie Wallace, RD,LD,CSP
• Kaci Waller, C-AA
• Richardd D Walls, D.M.D.
• Marie Walsh- Young, LPN, LMT
• Ashlie Walsh
• Colleen Elizabeth Walsh, LPC

• Professional Counselor in Marietta, GA
• Providers in Marietta, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; 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.