Carol L Wallace, MA, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC48746 Issued in CA

Practice address

2376 Maritime Dr
Suite 200
Elk Grove, CA 95758

Phone

(916) 531-5647

Fax

(916) 405-3470

NPI assigned

Mar 21, 2007

Last updated

Jun 3, 2018By the provider in NPPES

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 Arts

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

• Change by Coniah Family Counseling, a Professional Corporation

  • Marriage & Family Therapist
  • Elk Grove, CA
  • NPI 1467931022
  NPD (past) Authorized official

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527984000000",
    "number": "1912022492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2376 MARITIME DR",
            "address_2": "SUITE 200",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957583640",
            "telephone_number": "916-531-5647",
            "fax_number": "916-405-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2376 MARITIME DR",
            "address_2": "SUITE 200",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "95758",
            "telephone_number": "916-531-5647",
            "fax_number": "916-405-3470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8912 Volunteer Ln",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958263221",
            "country_code": "US",
            "telephone_number": "916-344-0199 x223",
            "fax_number": "916-344-0196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CAROL",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "MA,  LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2018-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC48746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Walker
• Megan Walker
• Monterya Walker
• Wallace Blake McKinney Medical Group of California
• Wallace J Bellamy DMD (Fountain Plaza Family Dental)
• Patricia A Wallrich, PA-C
• Walmart Inc. (Walmart Pharmacy 10-1697)
• Walmart Inc. (WalMart Pharmacy 10-5848)
• Walmart Inc. (WalMart Pharmacy 10-5683)
• Walmart Stores, Inc. (Vision Center 30-1697)

• Marriage & Family Therapist in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.