Amanda Wallace, LPCC-S

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.1000654 Issued in OH

Practice address

1 Perkins SQ
Akron, OH 44308-1063

Phone

(330) 543-5015

Fax

(330) 543-3942

NPI assigned

Jan 22, 2014

Sex

Female

Sole proprietor

No

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 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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awallace89142@direct.chmca.org

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  OH

  Medicare reassignment NPD
• Akron Children'S Hospital

  • Children's Hospital
  • Akron, OH
  • NPI 1942465752
  NPD
• Silver Lake Psychiatry, LLC

  • Psychiatry Physician
  • Stow, OH
  • NPI 1295304723
  NPD (past)
• Summitacademysecondaryschool-Akron

  • Local Education Agency (LEA)
  • Akron, OH
  • NPI 1487847216
  NPD (past)

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1154744563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "464 S HAWKINS AVE",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443201228",
            "telephone_number": "330-434-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PERKINS SQ",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443081063",
            "telephone_number": "330-543-5015",
            "fax_number": "330-543-3942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "464 S Hawkins Ave",
            "address_purpose": "LOCATION",
            "city": "Akron",
            "state": "OH",
            "postal_code": "443201228",
            "country_code": "US",
            "telephone_number": "330-434-2343",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1251 Nilles Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "OH",
            "postal_code": "450147205",
            "country_code": "US",
            "telephone_number": "513-939-0300",
            "fax_number": "513-939-0310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "credential": "LPCC-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-22",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.1000654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Subrena Walker, CDCA, QMHS, OCPSA
• Travis Lavar Walker
• Victoria Ea Walker, NP
• Zohntai Walker
• Palak Bharat Wall, MD
• Erin Wallace, LISW
• Latoska Wallace
• Randy Lamar Wallace Jr., M.D.
• Ryan James Wallace
• Sherrie S Wallace, D.P.M

• Mental Health Counselor in Akron, OH
• Providers in Akron, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.