Nicole Janeen Wallace, LCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A13547 Issued in NC

Practice address

3041 Berks Way Ste 102C
Raleigh, NC 27614-6777

Phone

(919) 925-2274

Fax

(919) 820-8571

NPI assigned

Feb 8, 2018

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

Not listed in the public Medicare enrollment file

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.

• Transformation Counseling & Consulting

  • Mental Health Counselor
  • Raleigh, NC
  • NPI 1689274292

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1154820868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 627",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275880627",
            "telephone_number": "919-306-2579",
            "fax_number": "919-820-8571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3041 BERKS WAY STE 102C",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276146777",
            "telephone_number": "919-925-2274",
            "fax_number": "919-820-8571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "174 Mine Lake Ct Ste 200",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276156417",
            "country_code": "US",
            "telephone_number": "919-618-6526",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7906 Hogan Dr",
            "address_purpose": "LOCATION",
            "city": "Wake Forest",
            "state": "NC",
            "postal_code": "275876659",
            "country_code": "US",
            "telephone_number": "919-306-2579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "NICOLE",
        "middle_name": "JANEEN",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-08",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A13547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Moreno Wallace, NP
• Jocelyn Jones Wallace, LCAS-A, LPC-A
• Julie Anne Wallace, LCMHCA
• Kaitlyn D Wallace, PT
• Kathryn Paige Wallace, CCC-SLP
• Sarah Wallace
• Senetra Wallace, LCSW
• David Wallach
• Andrea Wallenbeck
• Luke Allan Wallenbeck

• All providers in Raleigh, NC
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.