TARA BANKS WALLACE (NPI# 1457644585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457644585 |
| Entity Type | Individual |
| Full Name | TARA BANKS WALLACE |
| Credential | PSY.D. |
| Practice Address |
8626 Lee Hwy Ste 200 Fairfax VA 22031-2135 |
| Mailing Address |
12043 Elliots Oak Pl Bristow VA 20136-1265 |
| Practice Telephone | 5713930075 |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2011-05-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
0810004361 | VA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790124378 | Tara Wallace | Specialist | 2633 Babble Creek Ln, O Fallon, MO 63368-8338 | 2013-06-18 |
| 1780833442 | Tara Nicole Wallace | Occupational Therapist | 1905 W Beebe Capps Expy, Searcy, AR 72143-5012 | 2008-09-17 |
| 1902430002 | Tara Wallace | Behavior Technician | 1635 S Fry Rd, Katy, TX 77450-6404 | 2020-02-27 |
| 1811309875 | Tara Robin Wallace | Dietitian, Registered | 200 Elm St N, Onamia, MN 56359-7901 | 2014-05-27 |
| 1043633027 | Tara Wallace | Social Worker | 325 Sw Frazier Ave, Topeka, KS 66606-1963 | 2014-01-28 |
| 1972739134 | Tara Wallace | Counselor | 625 W Washington Ave, Madison, WI 53703-2637 | 2009-06-02 |
| Street Address |
8626 LEE HWY STE 200 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22031-2135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154941151 | Hannah Moss | Counselor | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2020-04-20 |
| 1740819978 | Rebecca Lyn Gillam, Ms, Lpc, Atr-bc | Counselor | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2020-04-08 |
| 1326670761 | Anel Alejandra Coss | Counselor | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2020-02-04 |
| 1780142711 | Quinn K Smelser | Counselor | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2019-03-08 |
| 1154894343 | Jennifer Catherine Hannett | Social Worker | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2019-01-10 |
| 1588137574 | Courtney Glickman | Counselor | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2019-01-02 |
| 1407375256 | Deborah M Lawton | Counselor | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2017-09-13 |
| 1932586781 | Rachel Altvater | Counselor | 8626 Lee Hwy Ste 200, Fairfax, VA 22031 | 2015-04-30 |
| 1417392747 | Gil Institute for Trauma Recovery and Education, LLC | Social Worker | 8626 Lee Hwy Ste 200, Fairfax, VA 22031-2135 | 2013-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902414105 | Su Jung Kang | Dentist | 9661-c Main Street, Fairfax, VA 22031 | 2020-07-14 |
| 1346896347 | Fuling Guo | Acupuncturist | 3013 James St, Fairfax, VA 22031 | 2019-08-15 |
| 1902458797 | Kayla Callister | Psychologist | 2270 Willow Oaks Corporate Drive, Fairfax, VA 22031 | 2019-07-11 |
| 1790349801 | Fairfax Dental Esthetics | Dentist | 9621 Fairfax Blvd., Fairfax, VA 22031 | 2019-04-24 |
| 1417427675 | Kathryn Yen Ho | Speech-Language Pathologist | 8270 Willow Oaks Corporate Drive Suite 2127, Falls Church, VA 22031 | 2018-11-30 |
| 1932681376 | Joanne Towers | Physician Assistant | 3025 Hamaker Court Suite 300, Fairfax, VA 22031 | 2018-09-01 |
| 1790262020 | S Renee Dennis | Nurse Practitioner | 8316 Arlington Blvd Ste 500, Fairfax, VA 22031 | 2018-07-19 |
| 1013493451 | Elizabeth Joan Dwyer | Physician Assistant | 3023 Hamaker Ct., Suite 500, Fairfax, VA 22031 | 2018-07-18 |
| 1316432669 | Delta Pharm LLC | Pharmacy | 8316 Arlington Blvd Ste 100, Fairfax, VA 22031 | 2018-06-28 |
| 1629567656 | Laura Breeden | Acupuncturist | 3846 Lyndhurst Dr Apt 301, Fairfax, Va, VA 22031 | 2018-05-04 |
| Find all providers in zip 22031 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093877300 | Susie Elizabeth Caron | Psychologist | 325 Swamp Rd, Fairfax, VT 05454-9777 | 2006-12-14 |
| 1770656035 | Childhelp,inc. | Psychologist | 11230 Waples Mill Rd Ste 105, Fairfax, VA 22030-6002 | 2006-11-16 |
| 1245685783 | Michelle Hendrickson | Psychologist | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2016-05-03 |
| 1285970087 | Catherine A Rathman | Psychologist | 11204 Waples Mill Rd, Fairfax, VA 22030-6036 | 2012-12-26 |
| 1407052905 | Deborah Cohen | Psychologist | 10339a Democracy Lane, Fairfax, VA 22030 | 2007-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083161368 | Nancy Watt Marin | Psychologist | 5060 37th St N, Arlington, VA 22207-1823 | 2016-09-05 |
| 1407221716 | Spectrum Psychological and Neurotherapy PC | Psychologist | 4542 Bonney Rd Ste B, Virginia Beach, VA 23462 | 2015-12-11 |
| 1346613668 | Brian Edward Razzino | Psychologist | 150 Little Falls St Ste 200, Falls Church, VA 22046-4315 | 2015-11-09 |
| 1538597448 | Jadig Garcia | Psychologist | 10571 Telegraph Rd Ste 110, Glen Allen, VA 23059-4652 | 2013-10-31 |
| 1629327226 | Angela Michelle Malo | Psychologist | 11480 Sunset Hills Rd, Reston, VA 20190-5265 | 2012-08-29 |
| 1093092272 | Peter F Cooper | Psychologist | 359 Sherwood Ave, Staunton, VA 24401-4430 | 2011-11-15 |
| 1972889871 | Sara Markese Phd Pllc | Psychologist | 2813 Lee Oaks Ct, Suite 304, Falls Church, VA 22046-7336 | 2011-10-24 |
| 1598088502 | Megan F Gerbracht | Psychologist | 1489 Chain Bridge Rd Ste 203, Mc Lean, VA 22101-5724 | 2010-03-04 |
| 1346572351 | Jill Allison Ferrante Gasper | Psychologist | 508 Libbie Ave, Suite 100, Richmond, VA 23226-2618 | 2010-02-02 |
| 1770754285 | Victor M. Huertas | Psychologist | 8232 La Faye Ct, Alexandria, VA 22306-3200 | 2008-03-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.