Active NPI
Tyshaundra Renee Wallace, M.ED, LCASA, QP
- Mental Health Counselor
- High Point, NC
National Provider Identifier
1669937595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCAS-25036
- Practice address
- 1001 Phillips Ave
High Point, NC 27262-7251 - Phone
- (336) 854-2560
- NPI assigned
- Feb 5, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCAS-25036 | NC | Primary |
Addresses
Primary practice location
1001 Phillips Ave
High Point, NC 27262-7251
Mailing address
438 Drum Rd Apt 8
Reidsville, NC 27320-9062
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-25036 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780963200000",
"number": "1669937595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "438 DRUM RD APT 8",
"city": "REIDSVILLE",
"state": "NC",
"postal_code": "273209062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 PHILLIPS AVE",
"city": "HIGH POINT",
"state": "NC",
"postal_code": "272627251",
"telephone_number": "336-854-2560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "TYSHAUNDRA",
"middle_name": "RENEE",
"credential": "M.ED, LCASA, QP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-05",
"last_updated": "2026-06-09",
"certification_date": "2026-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "LCAS-25036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in High Point, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.