Katherine H Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010461 Issued in VA

Practice address

12300 Washington Hwy
Ashland, VA 23005-7646

Phone

(804) 365-4166

Fax

(804) 365-4216

NPI assigned

May 9, 2018

Sex

Female

Sole proprietor

No

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 VA

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

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellspring Child and Family Psychology, PCGroup PAC ID 5294036513, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Wellspring Child and Family Psychology, PC

  • Clinical Psychologist
  • Fredericksburg, VA
  • NPI 1477962421
  Medicare reassignment Care Compare group NPD
• Hanover County Board of Supervisors

  • Mental Health Counselor
  • Ashland, VA
  • NPI 1104858653
  Medicare reassignment

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1801385349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 WASHINGTON HWY",
            "city": "ASHLAND",
            "state": "VA",
            "postal_code": "230057646",
            "telephone_number": "804-365-4166",
            "fax_number": "804-365-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 WASHINGTON HWY",
            "city": "ASHLAND",
            "state": "VA",
            "postal_code": "230057646",
            "telephone_number": "804-365-4166",
            "fax_number": "804-365-4216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KATHERINE",
        "middle_name": "H",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-09",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Cherie Michelle Walkley, MS, CCC-SLP, IBCLC
• Darshini Walton
• Kysha L. Washington, LPC
• Loren S Watson
• Wendy V Atkinson
• Karla K White, LPC

• Clinical Social Worker in Ashland, VA
• Providers in Ashland, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.