Darrell Dewayne Wallace Jr., LGPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LGP9687 Issued in MD

Practice address

107 E 25TH St
Baltimore, MD 21218-5213

Phone

(410) 558-0019

NPI assigned

Jul 26, 2019

Sex

Male

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564099200000",
    "number": "1265086367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 MARC RD # A",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211081525",
            "telephone_number": "443-694-7554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E 25TH ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212185213",
            "telephone_number": "410-558-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DARRELL",
        "middle_name": "DEWAYNE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LGPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-26",
        "last_updated": "2019-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LGP9687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Wallace
• Bernadette Wallace, CRNA
• Brendan Kiely Wallace
• Brian Wallace, MD
• Candace Wallace, CPT
• Darryl John Wallace, CSC-AD
• Desiree Wallace
• Edward Anthony Wallace
• Jerrol B Wallace, CRNA
• Joey Lynn Wallace

• 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 Jul 26, 2019; 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.