Mary Etheridge Wallace, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

12837 Issued in NC

Practice address

303 E. Main Street Suite 9
Elizabeth City, NC 27909

Phone

(252) 619-6629

Fax

(252) 331-2499

NPI assigned

Feb 27, 2013

Sex

Female

Sole proprietor

No

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

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.

• Nehemiah Christian Counseling, P.L.L.C.

  • Professional Counselor
  • Elizabeth City, NC
  • NPI 1154840759
  NPD (past) Authorized official

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

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1801136809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E. MAIN STREET SUITE 9",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279094452",
            "telephone_number": "252-619-6629",
            "fax_number": "252-331-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E. MAIN STREET SUITE 9",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "27909",
            "telephone_number": "252-619-6629",
            "fax_number": "252-331-2499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "281 Independence Blvd",
            "address_2": "Suite 326",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234622986",
            "country_code": "US",
            "telephone_number": "757-490-0377",
            "fax_number": "757-497-1327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARY",
        "middle_name": "ETHERIDGE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-27",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701005385",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "12837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara Waldrop, NP-C
• Walgreen Co
• Amelia Morgan Walker, LCSW
• Emily Jane Walker
• Geraldine Walker, LCAS
• Rosemary Wiseman Wallio, LCSW
• Rebecca Elizabeth Wallman, PA
• Elizabeth Rae Wanzer, CRNA
• Marie Latendresse Ward, M.S., R.D., C.D.E.
• Greg A Warren, DO

• Professional Counselor in Elizabeth City, NC
• Providers in Elizabeth City, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; 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.