Constance Wallace, M.S., LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC005431 Issued in GA

Practice address

1222 Lincoln Court Ave NE
Atlanta, GA 30329-1825

Phone

(678) 641-4415

NPI assigned

Jul 18, 2009

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1247875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247875200000",
    "number": "1902036452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 LINCOLN COURT AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303291825",
            "telephone_number": "678-641-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 LINCOLN COURT AVE NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303291825",
            "telephone_number": "678-641-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CONSTANCE",
        "credential": "M.S., LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-18",
        "last_updated": "2009-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "LPC005431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonita Lucille Wallace, LPC
• Bradley A Wallace, MD
• Caroline Barwick Wallace, CRNA
• Chasity Wallace
• Colby Evan Wallace, D.P.T.
• Felecia Zanetta Wallace, LMT, CMT
• Grant Wallace
• Gregory Stephen Wallace, MD
• Guy Wallace
• Jaclyn Renee Wallace, NNP-BC

• Mental Health Counselor in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2009; 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.