Lisa Buckner Wallace, LCMHCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A13854 Issued in NC

Practice address

3750 N Center St
Hickory, NC 28601-8089

Phone

(828) 327-3491

NPI assigned

Mar 21, 2019

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

Enrolled in NC

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

Interoperability endpoints

• Direct secure messaging: lwallace318820@direct.ochin.org

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.

• Gaston Family Health Services, Inc.

  dba Kintegra Family Medicine - Hudson

  • Federally Qualified Health Center (FQHC)
  • Gastonia, NC
  • NPI 1215932215
  Medicare reassignment NPD
• Gaston Family Health Services, Inc

  dba Kintegra Family Medicine - Xray Dr

  • Federally Qualified Health Center (FQHC)
  • Gastonia, NC
  • NPI 1306644315
  NPD

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1598225930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358",
            "telephone_number": "704-874-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 N CENTER ST",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286018089",
            "telephone_number": "828-327-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "middle_name": "BUCKNER",
        "name_prefix": "Mrs.",
        "credential": "LCMHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-21",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A13854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason A Walker, M.D.
• Lauren Walker, FNP-C
• Lindsey Walker
• Rhonda Lea Walker, LCSW
• Scott W. Walker, MD
• Steven James Walls, PHARMD
• Walnut Medical Inc
• Alicia Ann Walsh, MD
• Walter L. King, MD (Viewmont Eye Associates)
• Madison Ann Walters

• Mental Health Counselor in Hickory, NC
• Providers in Hickory, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; 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.