Triphinia M Wallace, PSY.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

GA003723 Issued in GA

Practice address

4062 Peachtree Rd NE # 190a
Brookhaven, GA 30319-3021

Phone

(404) 317-2283

Fax

(404) 393-6692

NPI assigned

Mar 9, 2007

Reactivated

Nov 15, 2022

Last updated

Mar 14, 2025By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  Psychologist

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  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1902938558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4062 PEACHTREE RD NE # 190A",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303193021",
            "telephone_number": "404-317-2283",
            "fax_number": "404-393-6692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4062 PEACHTREE RD NE # 190A",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303193021",
            "telephone_number": "404-317-2283",
            "fax_number": "404-393-6692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TRIPHINIA",
        "middle_name": "M",
        "credential": "PSY.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "deactivation_date": "2022-08-17",
        "reactivation_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "GA003723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cheryl D Walker
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• Psychologist in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; 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.