Kimberly Wallace LPC LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

KIMBERLY WALLACE LPC LLC

Practice address

2852 Johnson Ferry Rd Ste 100
Marietta, GA 30062-5686

Phone

(404) 906-9831

NPI assigned

Sep 19, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kimberly Wallace, LPCNPI 1083091987

Title

Owner/Provider

Phone

(404) 906-9831

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Wallace, LPC

  • Professional Counselor
  • Marietta, GA
  • NPI 1083091987
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1600473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700784000000",
    "number": "1659987238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2852 JOHNSON FERRY RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625686",
            "telephone_number": "404-906-9831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2852 JOHNSON FERRY RD STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625686",
            "telephone_number": "404-906-9831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY WALLACE LPC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-19",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "404-906-9831",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seonghyeon Kim, DDS
• Stephanie Kim
• Stephen Kim, M.D.
• Kay Ann Kimball, CNP
• Johanna Kimberl, PA-C
• Candance Kimbrough-Green, M.D.
• Kimchang & Company, LLC
• Kirk Andrew Kimmerling, D.D.S.
• Patricia White Kimmerling, D.D.S.
• Felicia Cohila Kincaid, RN

• Professional Counselor in Marietta, GA
• Providers in Marietta, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.