Elaine Marie Wallace, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LC13561 Issued in MD

Practice address

204 Somerset Bay Dr Apt 201
Glen Burnie, MD 21061-6476

Phone

(410) 903-8473

NPI assigned

Apr 22, 2021

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

Enrolled in MD, PA, SC3 enrollments

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 3

Specialty

Mental Health Counselor

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mental Health Specialty Group PAGroup PAC ID 8921466228, 726 clinicians

Sondermind Provider Network LLCGroup PAC ID 9537572490, 1,295 clinicians

Safe Harbor Behavioral Care Chesapeake LLCGroup PAC ID 0042578171, 9 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Safe Harbor Behavioral Care Chesapeake LLC

  • Clinical Social Worker
  • Annapolis, MD
  • NPI 1295246718

  Professional

  Medicare reassignment Care Compare group NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  MD, Professional

  Medicare reassignment Care Compare group NPD
• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  MD, Professional, SC

  Medicare reassignment Care Compare group NPD
• Sondermind, P.a.

  • Clinical Social Worker
  • Wichita, KS
  • NPI 1710647581

  PA

  Medicare reassignment NPD
• Uri Christian Counseling, LLC

  • Professional Counselor
  • Glen Burnie, MD
  • NPI 1194500736
  NPD
• Safe Harbor Behavioral Care, LLC

  • Clinical Social Worker
  • Bel Air, MD
  • NPI 1316487879

  Professional

  NPD (past)
• Safe Harbor Christian Counseling of Annapolis Inc

  • Clinical Social Worker
  • Arnold, MD
  • NPI 1447407523
  NPD (past)

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1962084574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 SOMERSET BAY DR APT 201",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616476",
            "telephone_number": "410-903-8473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SOMERSET BAY DR APT 201",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616476",
            "telephone_number": "410-903-8473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ELAINE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-22",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC13561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cierra Ann Walker
• Walker'S Group Assisted Living
• Michele Jacqueline Walklett, PSYD
• Ariel Nicole Wallace, OT
• Danielle Marie Wallace
• Elron J Wallace, MD
• Teri L Walos, RN
• Charles Walsh, LCADC
• Stephanie Hunt Walsh, MD
• Monaa Walton, NP

• Professional Counselor in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Professional Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.