MRS. BONITA LUCILLE WALLACE (NPI# 1912364787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912364787 |
| Entity Type | Individual |
| Full Name | MRS. BONITA LUCILLE WALLACE |
| Credential | LPC |
| Practice Address |
550 Pharr Rd Ne Suite 605 Atlanta GA 30305-3428 |
| Practice Telephone | 4046646398 |
| Practice Fax Number | 6787052758 |
| Mailing Telephone | 4046646398 |
| Mailing Fax Number | 6787052758 |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-01-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
1823 | GA | Behavioral Health & Social Service Providers |
| Street Address |
550 PHARR RD NE SUITE 605 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30305-3428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063471324 | Peachtree Oral & Maxillofacial Surgery Associates | Dentist | 550 Pharr Rd Ne, Suite 325, Atlanta, GA 30305-3428 | 2006-03-23 |
| 1902253750 | Monique Pamphile | Acupuncturist | 550 Pharr Rd Ne, Suite 410, Atlanta, GA 30305-3428 | 2016-05-23 |
| 1982066809 | Acuwellness Atlanta Inc. | Acupuncturist | 550 Pharr Rd Ne, Suite 410, Atlanta, GA 30305-3428 | 2016-03-22 |
| 1528369964 | Valerie S Marler,ph.d.,p.c. | Psychologist | 550 Pharr Rd Ne, Suite 205, Atlanta, GA 30305-3428 | 2010-11-16 |
| 1770731804 | Karla Aitme Viera | Psychiatry & Neurology | 550 Pharr Rd Ne, Suite 605, Atlanta, GA 30305-3428 | 2008-09-03 |
| 1083873640 | Michael Mchaney Demo | Dentist | 550 Pharr Rd Ne, Suite 325, Atlanta, GA 30305-3428 | 2008-06-08 |
| 1932223740 | Gregory Paul Marks | Dentist | 550 Pharr Rd Ne, Suite 325, Atlanta, GA 30305-3428 | 2007-03-19 |
| 1386780369 | Valerie S. Marler | Psychologist | 550 Pharr Rd Ne, Suite 205, Atlanta, GA 30305-3428 | 2007-01-29 |
| 1568558872 | Marla Beth Shapiro | Clinical Neuropsychologist | 550 Pharr Rd Ne, Suite 605, Atlanta, GA 30305-3428 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659981322 | Gerald E Roettger | Physical Therapist | 2955 Peachtree Road Nw, Suite A1, Atlanta, GA 30305 | 2020-08-06 |
| 1689202681 | Pt Hills Place Terraces LLC | Assisted Living Facility | 229 Peachtree Hills Place, Atlanta, GA 30305 | 2020-03-27 |
| 1043704299 | Alyssa Elrod Utz | Pharmacist | 3495 Piedmont Road, First Floor, Suite 110, Atlanta, GA 30305 | 2018-06-20 |
| 1508373689 | Kathryn Gohde | Counselor | 3525 Piedmont Rd Nw, Bldg 7 Suite 408, Atlanta, GA 30305 | 2018-01-10 |
| 1386195154 | Ryan Gabriel Wilkins | Physical Therapist | 550 Pharr Rd Ne Ste 550, Atlanta, GA 30305 | 2016-10-17 |
| 1821440587 | Monica Martinez Dicristina | Counselor | 3525 Piedmont Road, Building 7, Suite 408, Atlanta, GA 30305 | 2016-07-06 |
| 1164879532 | Brittany Nicole Albritton | Physical Therapist | 3169 Maple Drive Ne, Atlanta, GA 30305 | 2016-05-16 |
| 1588039275 | Alaina Blevins | Physician Assistant | 240 Pharr Rd Ne, Atlanta, GA 30305 | 2015-12-07 |
| 1558750141 | A2h2 | Clinic/Center | 2909 Peachtree Rd; Nw;, Atlanta, GA 30305 | 2015-01-20 |
| 1144619016 | We Up Home Health Services LLC | Clinic/Center | 2909 Peachtree Rd; Nw, Atlanta, GA 30305 | 2015-01-15 |
| Find all providers in zip 30305 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245830140 | Tiffany Alberto | Counselor | 350 Lyndale Dr Se, Atlanta, GA 30316-2692 | 2020-10-29 |
| 1356940712 | Shoshana Dayanim Agichtein | Counselor | 1380 Jody Ln Ne, Atlanta, GA 30329-3522 | 2020-10-18 |
| 1285231951 | Mecall Pearson | Counselor | 1350 Spring St Nw Ste 225, Atlanta, GA 30309-2866 | 2020-10-06 |
| 1447862172 | Dr. Burwell Speaks, LLC | Counselor | 3495 Buckhead Loop Ne Ste 1112, Atlanta, GA 30326-1528 | 2020-08-24 |
| 1386254761 | Jocelyn Patterson Mosley | Counselor | 2030 Gramercy Cir, Atlanta, GA 30341-1779 | 2020-07-31 |
| 1205444718 | Vanessa Lorraine Elizabeth Johnson | Counselor | 1388 Gates Cir Se, Atlanta, GA 30316-4092 | 2020-07-21 |
| 1891303426 | Cheryl E Williams | Counselor | 1870 The Exchange, Suite 200 - 361, Atlanta, GA 30339 | 2020-07-20 |
| 1376161760 | Lisa J Strube | Counselor | 49 Lenox Pointe Ne Ste C, Atlanta, GA 30324-7426 | 2020-07-11 |
| 1881210201 | Destiny Winters | Counselor | 900 Dekalb Ave Ne Ste K, Atlanta, GA 30307-2501 | 2020-06-22 |
| 1912522582 | Dorian Ellis | Counselor | 5470 Lemoyne Dr Sw, Atlanta, GA 30331-9206 | 2020-06-10 |
| Find all providers in ATLANTA | ||||
Please comment or provide details below to improve the information on MRS. BONITA LUCILLE WALLACE.
| 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.