MEDICARE: MRS. ASHLEY H WALLACE ED.S, LAPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	APC009108	GA

General Provider Information

NPI Number	:	1225854243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY H WALLACE ED.S, LAPC, NCC

Provider Business Mailing Address
First Line	:	10745 MISTY MEADOWS CT
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6162
Country	:	US
Telephone Number	:	470-516-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	10745 MISTY MEADOWS CT
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6162
Country	:	US
Telephone Number	:	470-516-1229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	04/15/2026

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