Quanesha Wallace, LPC-R

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0704014373 Issued in VA

Practice address

3143 Magic Hollow Blvd Ste 100
Virginia Beach, VA 23453-3077

Phone

(757) 385-6940

NPI assigned

Mar 27, 2023

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 DC

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

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

  DC, Professional

  Medicare reassignment NPD
• L.I.F.T Counseling

  • Professional Counselor
  • Portsmouth, VA
  • NPI 1184488595
  NPD Authorized official
• C.a.R.E LLC

  • Mental Health Counselor
  • Norfolk, VA
  • NPI 1689246118
  NPD (past)

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1447953435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 HIGH ST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237043105",
            "telephone_number": "804-551-4292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3143 MAGIC HOLLOW BLVD STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234533077",
            "telephone_number": "757-385-6940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 High St",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237043105",
            "country_code": "US",
            "telephone_number": "804-551-4292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "QUANESHA",
        "credential": "LPC-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0704014373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Wallace, L.AC.
• Holly Wallace, M.ED., CCC-SLP
• Kiyosia Wallace
• Marsha Wallace
• Nicole Marie Wallace, PT
• Shayla Wallace
• Tiffany Wallace, QMHP
• Ian T Walloch
• Kaitlin Suzanne Walsh, MSED
• Madeline Walsh

• Professional Counselor in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.