LISA WALLACE (NPI# 1992125892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992125892 |
| Entity Type | Individual |
| Full Name | LISA WALLACE |
| Practice Address |
2392 Edgewood Ave N Jacksonville FL 32254-1725 |
| Practice Telephone | 9047810600 |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2015-03-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396368064 | Lisa Jean Wallace | Occupational Therapy Assistant | 480 Somerset St Unit 1, North Plainfield, NJ 07060-4018 | 2020-05-28 |
| 1336779925 | Lisa Wallace | Counselor | 2769 Iris Ave Ste 107, Boulder, CO 80304-4405 | 2020-01-22 |
| 1710521968 | Lisa Anne Wallace | Counselor | 418 Barr Rd, Lexington, SC 29072-2363 | 2019-10-31 |
| 1598225930 | Lisa Buckner Wallace | Counselor | 3750 N Center St, Hickory, NC 28601-8089 | 2019-03-21 |
| 1235637182 | Lisa M. Wallace | Nurse Practitioner | 800 E Cheves St Ste 200, Florence, SC 29506-2651 | 2018-01-25 |
| 1134575475 | Lisa Wallace | Counselor | 14 Farmer Rd, Milton, MA 02186-3743 | 2016-05-05 |
| 1720476641 | Lisa Wallace | Registered Nurse | 7601 Hospital Dr Ste 202, Sacramento, CA 95823-5408 | 2014-12-30 |
| 1134438286 | Lisa M Wallace | Nurse Practitioner | 831 N Theatre Drive, Marion, IN 46952-1701 | 2010-10-06 |
| 1124002571 | Lisa M Wallace | Counselor | 1807 Capitol Ave, Suite 101 A, Cheyenne, WY 82001-4544 | 2005-11-30 |
| 1003423658 | Lisa Carol Wallace | Nurse Practitioner | 2418 180th St, Allerton, IA 50008-8715 | 2020-09-28 |
| Street Address |
2392 EDGEWOOD AVE N |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32254-1725 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023016839 | Northwest Behavioral Health Services, Inc. | Case Management | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2005-07-14 |
| 1073110508 | Tia Denise Womack | Counselor | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-10-07 |
| 1073128088 | Catherine Knight | Counselor | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-09-15 |
| 1063022374 | Denzal Dillard | Social Worker | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-08-03 |
| 1447860663 | Shawnee Kereenyaga | Social Worker | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-08-03 |
| 1851919641 | Titus L Kent Sr. | Social Worker | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-07-08 |
| 1558999722 | Antia R Henderson | Case Manager/Care Coordinator | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-04-01 |
| 1992331011 | Northwest Behavioral Health | Case Management | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-03-20 |
| 1588294086 | Beatrice I Elias | Counselor | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-01-23 |
| 1063052421 | Kimberly Eugenia Ruise | Social Worker | 2392 Edgewood Ave N, Jacksonville, FL 32254-1725 | 2020-01-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730673385 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1301 W Palm Ave Ste 210, Jacksonville, FL 32254 | 2018-06-18 |
| 1578072112 | Jules M Jean-pierre | Counselor | 2392 North Edgewood Avenue, Jacksonville, FL 32254 | 2017-09-27 |
| 1356869051 | Volaura Shanae Anderson | Counselor | 590 Ellis Rd, Jacksonville, FL 32254 | 2017-09-01 |
| 1962928291 | Angel Spivie | Counselor | 590 Ellis Road South Building 4, Jacksonville, FL 32254 | 2017-08-18 |
| 1376072777 | Tarkeshia Shuman | Contractor | 3150 Broadway Ave, Jacksoville, FL 32254 | 2017-06-08 |
| 1770931636 | Mamie Faith Peterson-mclaurn | Home Health | 2747 Sophia St, Jax, FL 32254 | 2016-06-01 |
| 1760803373 | Marian Lavonne Jones | Custodial Care Facility | 3501 Centerhill Dr. North, Jacksonville, FL 32254 | 2013-12-27 |
| 1659543981 | Monique Bosque-perez | Family Medicine | 781 Edgewood Ave N, Ufjp Commonwealth Family Practice, Jacksonville, FL 32254 | 2008-03-26 |
| 1508906652 | James Keith Riesz | Physical Therapist | 800 Lomax Street, Suite 105, Jacksonville, FL 32254 | 2007-02-07 |
| 1003903865 | Sabrina F Sessions | Pharmacist | 5050 Edgewood Court, Jacksonville, FL 32254 | 2006-10-05 |
| Find all providers in zip 32254 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720519 | Ashley Harms | Counselor | 4070 Herschel St Ste 1, Jacksonville, FL 32210-2239 | 2020-11-03 |
| 1902418684 | Molly Ann Burkhardt | Counselor | 5776 Saint Augustine Rd # 8030, Jacksonville, FL 32207-8046 | 2020-08-23 |
| 1194335638 | Aiteria Green | Counselor | 9713 Bridgeway Ave, Jacksonville, FL 32222-2913 | 2020-08-07 |
| 1053920116 | Barbara Burden | Counselor | 209 N Carole Dr, Jacksonville, NC 28546-4845 | 2020-07-24 |
| 1790393973 | Kelley Holladay | Counselor | 1782 Plantation Oaks Dr, Jacksonville, FL 32223-5010 | 2020-07-14 |
| 1629696646 | Mary Ann Caldwell | Counselor | 2496 Northwoods Dr., Jacksonville, NC 28540 | 2020-07-07 |
| 1447877709 | Quendria Johnson-kerns | Counselor | 200 Zonnie Ln, Jacksonville, NC 28540-9729 | 2020-07-02 |
| 1467077164 | Shanna Horan | Counselor | 13500 Sutton Park Dr S Ste 702, Jacksonville, FL 32224-5290 | 2020-06-09 |
| 1720602527 | Shannon E Raikes | Counselor | 13990 Bartram Park Blvd Unit 209, Jacksonville, FL 32258-5543 | 2020-06-08 |
| 1750905253 | Kathlena N Reed | Counselor | 4131 University Blvd S Fl 32216, Jacksonville, FL 32216-4326 | 2020-06-01 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32254 |
Please comment or provide details below to improve the information on LISA 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.