Ty'Cristian Q. Wallace, LGPC, CAC-ADS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LGP15614 Issued in MD

Practice address

638 N Gilmor St
Baltimore, MD 21217-2101

Phone

(410) 462-2268

NPI assigned

Sep 13, 2022

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1663027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1255053609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 DUNMORE RD APT A",
            "city": "DUNDALK",
            "state": "MD",
            "postal_code": "212225125",
            "telephone_number": "443-845-4639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "638 N GILMOR ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212172101",
            "telephone_number": "410-462-2268"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "829 Fieldcrest Rd",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MD",
            "postal_code": "216139423",
            "country_code": "US",
            "telephone_number": "410-228-8101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TY'CRISTIAN",
        "middle_name": "Q.",
        "credential": "LGPC, CAC-ADS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-13",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LGP15614",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "AC3232",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelli Wallace
• Stephanie Wallace, C.R.N.A.
• Taylor Julia Wallace
• Theresa Wallace
• Trezure Wallace
• Zachary Wallace
• Sara Wallam, MD
• Jana Wallen
• Matthew H Wallengren, DDS, PA
• Ami C. Waller

• Mental Health Counselor in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Mental Health Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; 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.