CAROLYN ANN WALLACE (NPI# 1306470455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306470455 |
| Entity Type | Individual |
| Full Name | CAROLYN ANN WALLACE |
| Credential | LCADC |
| Practice Address |
2600 W Broadway Louisville KY 40211-1366 |
| Mailing Address |
323 N 42nd St Louisville KY 40212-2747 |
| Practice Telephone | 5026904286 |
| Mailing Telephone | 5023568210 |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2020-05-06 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
260417 | KY | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 323 N 42nd St, Louisville, KY 402122747 | 5023568210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356547509 | Carolyn Wallace | Counselor | 1400 Hensley Dr, Tahlequah, OK 74464-5221 | 2007-06-25 |
| 1023141363 | Carolyn Ann Wallace | Counselor | 25 Middle St, Portland, ME 04101-4869 | 2007-03-14 |
| 1962595835 | Carolyn Wallace | Social Worker | 50 Pleasant St, Northampton, MA 01060-3909 | 2006-10-02 |
| Street Address |
2600 W BROADWAY |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40211-1366 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164722831 | Brenda Clay Stoner | Chiropractor | 2600 W Broadway, Suite 208, Louisville, KY 40211-1366 | 2010-10-28 |
| 1215253372 | William Goldwair | Physical Therapy Assistant | 2600 W Broadway, Louisville, KY 40211-1366 | 2010-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942792940 | Kare LLC | Dentist | 2500 W Broadway Ste 500, Louisville, KY 40211 | 2018-06-05 |
| 1265943716 | Practicare Home Care Services, LLC | Nurse Practitioner | 1667 Russell Lee Dr, Louisville, KY 40211 | 2017-10-23 |
| 1518478221 | Latoya Samantha Hall | Counselor | 646 South 36th Street, Louisville, KY 40211 | 2017-10-20 |
| 1003071200 | Mark Cassol Md Psc | Ophthalmology | 2600 W. Broadway, Suite 105, Louisville, KY 40211 | 2008-07-28 |
| 1194919548 | Hardin Housing Corp | Assisted Living Facility | 2035 S 41st St, Louisville, KY 40211 | 2007-08-29 |
| 1184770562 | Eta Day Care Center LLC | Case Management | 724 So 44th Street, Louisville, KY 40211 | 2007-01-26 |
| 1871571356 | Alice C Gunnison | Physician Assistant | 2406 West Broadway, Jencare Neighborhood Medical Center West Broadway, LLC, Louisville, KY 40211 | 2006-01-05 |
| 1730733783 | Mark A Bush | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-07-29 |
| 1407419237 | Gina M Beckford | Nurse Practitioner | 3015 Wilson Ave, Louisville, KY 40211 | 2019-04-17 |
| 1730694266 | Orchid House, Inc. | Early Intervention Provider Agency | 703 S 31st St, Louisville, KY 40211 | 2017-12-06 |
| Find all providers in zip 40211 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700496569 | Nicole Kristina Doza | Counselor | 9720 Park Plaza Ave Unit 104, Louisville, KY 40241-2289 | 2020-08-06 |
| 1447860572 | Jordan Mceuen | Counselor | 645 S Roy Wilkins Ave Ste 100, Louisville, KY 40203-2072 | 2020-08-04 |
| 1023633674 | Ky Behavioral Solutions | Counselor | 12700 Townepark Way Ste 341, Louisville, KY 40243-2381 | 2020-06-10 |
| 1386284214 | Aa&associates of Kentucky LLC | Counselor | 3038 Breckenridge Ln Ste 204, Louisville, KY 40220-2195 | 2020-01-08 |
| 1861039661 | Campbellsville University | Counselor | 4420 Dixie Hwy Ste 230, Louisville, KY 40216-2986 | 2019-11-30 |
| 1720642374 | Yolanda Carnessali-powell | Counselor | 1448 S 15th St, Louisville, KY 40210-1838 | 2019-04-30 |
| 1538622295 | Stephanie Amber Gentile | Counselor | 1169 Eastern Pkwy Ste 1124, Louisville, KY 40217-1462 | 2019-04-10 |
| 1881166999 | Aileen M Bryant-wales | Counselor | 2133 W Market St, Louisville, KY 40212-1532 | 2018-12-31 |
| 1043710338 | Erin Dawn Jarrett | Counselor | 1939 Goldsmith Ln Ste 147, Louisville, KY 40218-3047 | 2018-02-13 |
| 1265946859 | Yolonda J Armstead | Counselor | 12730 Townepark Way Ste 201, Louisville, KY 40243-2303 | 2017-11-19 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40211 |
Please comment or provide details below to improve the information on CAROLYN ANN 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.