Cynthia Lewis Wallace, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810005436 Issued in VA

Practice address

2817 Reilly St
Fort Bragg, NC 28310-1078

Phone

(910) 907-6999

NPI assigned

May 24, 2016

Sex

Female

Sole proprietor

Yes

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1508213158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 EVANS CREST LN",
            "city": "HOLLY SPRINGS",
            "state": "NC",
            "postal_code": "275406181",
            "telephone_number": "440-503-7071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 REILLY ST",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283101078",
            "telephone_number": "910-907-6999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS WALLACE",
        "first_name": "CYNTHIA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-24",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005436",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "5096",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vimarys Leiwalo, DNP, CRNA
• Janice Marie Leslie, RN
• Kristen Rochelle Lessman, LCSW
• Joseph L Lester, MD
• Tyler Gray Levick, M.D.
• Amanda Lewis, FNP
• David Wilton Lewis Sr., PA-C
• Eric Chad Lewis Jr., PHARMD
• Nancy Renee Lewis, RD
• Philip Lewis, MS, RD, CSSD, CSCS

• Clinical Psychologist in Fort Bragg, NC
• Providers in Fort Bragg, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.