KRISTIN WALLACE (NPI# 1154931129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154931129 |
| Entity Type | Individual |
| Full Name | KRISTIN WALLACE |
| Practice Address |
940 Ebenezer Blvd Madison MS 39110-6002 |
| Mailing Address |
437 Pin Oak Dr Madison MS 39110-9365 |
| Practice Telephone | 6017900583 |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2020-08-05 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
M8300 | MS | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437455219 | Kristin Marie Wallace | Occupational Therapist | 2110 Washington Blvd Ste. 158, Arlington, VA 22204 | 2011-01-27 |
| 1922303007 | Kristin Kirby Wallace | Counselor | 4256 Four Lakes Dr, Melbourne, FL 32940-1222 | 2011-01-20 |
| 1568749026 | Kristin Renee Wallace | Pharmacist | 3510 Evergreen Pkwy, Evergreen, CO 80439-7707 | 2011-11-11 |
| 1366745804 | Kristin Nicole Wallace | Specialist | 1506 S Oneida St, Appleton, WI 54915-1305 | 2010-12-06 |
| Street Address |
940 EBENEZER BLVD |
| City | MADISON |
| State | MS |
| Zip Code | 39110-6002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710396205 | Roane Hunter Sr. | Counselor | 940 Ebenezer Blvd, Madison, MS 39110-6002 | 2014-08-08 |
| 1740748201 | Betty Lee Spencer | Social Worker | 940 Ebenezer Blvd, Madison, MS 39110-6002 | 2019-03-04 |
| 1265998132 | Clinton Aaron Wilson | Counselor | 940 Ebenezer Blvd, Madison, MS 39110-6002 | 2019-02-15 |
| 1710443684 | Sarah Linfield Wilson | Counselor | 940 Ebenezer Blvd, Madison, MS 39110-6002 | 2019-02-15 |
| 1336658756 | Michael Preston | Counselor | 940 Ebenezer Blvd, Madison, MS 39110-6002 | 2017-09-28 |
| 1356898837 | Sarah Beth Walker | Counselor | 940 Ebenezer Blvd, Suite B, Madison, MS 39110 | 2016-09-01 |
| 1982086641 | Turning Point Counseling | Counselor | 940 Ebenezer Blvd, Suite B, Madison, MS 39110 | 2015-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306446257 | Richard Harry Goldberg | Social Worker | 1514 Wood Ln, Madison, WI 53705-1457 | 2020-10-29 |
| 1710586219 | Megan Beckler | Social Worker | 49 Kessel Ct Bldg 25, Madison, WI 53711-6200 | 2020-10-26 |
| 1003436759 | Creating Space, LLC | Social Worker | 1915 Winnebago St Ste 101, Madison, WI 53704-5322 | 2020-04-23 |
| 1871143370 | Cecilia Goldschmidt | Social Worker | 2445 Darwin Rd Ste 15, Madison, WI 53704-3116 | 2019-09-17 |
| 1699321760 | Golden Vibes Counseling Center | Social Worker | 303 S Paterson St, Madison, WI 53703-4528 | 2019-08-14 |
| 1285293530 | Bianca Whitney | Social Worker | 506 Charles Ln, Madison, WI 53711-1312 | 2019-06-11 |
| 1598322505 | Judith Coursen Stevens | Social Worker | 147 Durham Road, Madison, CT 06443-1262 | 2019-05-24 |
| 1750840575 | Kimberly Michelle Horton | Social Worker | 102 Crabapple Grv, Madison, MS 39110-7098 | 2019-03-19 |
| 1497211387 | Latasha Monique Williams | Social Worker | Patriot Place (va), 314 Williams Avenue, Ste. 100, Madison, TN 37115 | 2019-02-15 |
| 1528536976 | Emily Elizabeth Morris | Social Worker | 4002 Nakoosa Trl, Madison, WI 53714-1314 | 2018-11-04 |
| Find all providers in MADISON | ||||
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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.