Individual provider Active NPI

Chakiah Wallace, LAC

  • Counselor
  • Little Rock, AR
National Provider Identifier
1902629199
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
A2411012 Issued in AR
Practice address
6501 W. 12TH, Street
Little Rock, AR 72204-1511
Phone
(501) 666-8686
Fax
(501) 660-6832
NPI assigned
Nov 5, 2024
Last updated
Sep 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X A2411012 AR Primary
Counselor 101Y00000X NU
Mental Health Counselor 101YM0800X A2411012 AR
Mental Health Counselor 101YM0800X NU

Addresses

Primary practice location

6501 W. 12TH, Street
Little Rock, AR 72204-1511

Mailing address

P.O. Box 251970
Little Rock, AR 72225-1970
Phone (501) 666-8686

Other practice location 1

11215 Hermitage Rd Ste 204
Little Rock, AR 72211-3864
Phone (501) 777-5969

Other practice location 2

513 Main St
North Little Rock, AR 72114-5329
Phone (501) 777-5969

Other names 1

  • Chakiah Elaine Wallace Other name

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

State licenses

LicenseStateTypeSpecialty
A2411012ARMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
McCoy Counseling LLC Counselor CurrentSince Nov 1, 2024 Accepting new patients
Mental Wellness Connection Mental Health CurrentSince Mar 20, 2025 Accepting new patients

Locations

11215 Hermitage Rd
Ste 204
Little Rock, AR 72211
Phone (501) 283-7201

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1730764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789603200000",
    "number": "1902629199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 251970",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722251970",
            "telephone_number": "501-666-8686",
            "fax_number": "501-660-6830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 W. 12TH, STREET",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722041511",
            "telephone_number": "501-666-8686",
            "fax_number": "501-660-6832"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11215 Hermitage Rd Ste 204",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722113864",
            "country_code": "US",
            "telephone_number": "501-777-5969",
            "fax_number": "501-379-9791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "513 Main St",
            "address_purpose": "LOCATION",
            "city": "North Little Rock",
            "state": "AR",
            "postal_code": "721145329",
            "country_code": "US",
            "telephone_number": "501-777-5969",
            "fax_number": "501-379-9791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHAKIAH",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-05",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "A2411012",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A2411012",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHAKIAH",
            "last_name": "WALLACE",
            "middle_name": "ELAINE",
            "credential": "LAC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.

Verify at the official NPI Registry.