Letitia J Wallace, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024193187 Issued in VA

Practice address

8401 Mayland Dr # 5766
Richmond, VA 23294-4648

Phone

(804) 635-6535

NPI assigned

Aug 5, 2015

Last updated

Jun 26, 2025By the provider in NPPES

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: letitia.wallace.p1@direct.d19csb.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Your Mind Matters LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Richmond, VA
  • NPI 1972491843
  NPD Authorized official

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

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1619353224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 MAYLAND DR # 5766",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232944648",
            "telephone_number": "804-635-6535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 MAYLAND DR # 5766",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232944648",
            "telephone_number": "804-635-6535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 W Bank St",
            "address_purpose": "LOCATION",
            "city": "Petersburg",
            "state": "VA",
            "postal_code": "238033279",
            "country_code": "US",
            "telephone_number": "804-862-8002 x3025",
            "fax_number": "804-862-8023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LETITIA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-05",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001236086",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024193187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ra'Jon Anthony Wall
• Annmarie Wallace-Smith
• Diana Wallace
• Katherine Lee Wallace, LCSW
• Laura Wallace
• Matthew Malone Wallace, M.D.
• Morgan Lindsey Wallace
• Nancy V Wallace, NP
• Narquinta Lashay Wallace, LPN
• Rachel Wallace, PHD

• Psychiatric/Mental Health Nurse Practitioner in Richmond, VA
• Providers in Richmond, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; 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.