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General NPI Number Information
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NPI Number | 1710810718
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Entity Type | Individual
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Provider Name | DANA WALLACE PHD, LPC-S, NCC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 201 RUE BEAUREGARD # 202
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City | LAFAYETTE
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State | LA
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Zip | 70508-3251
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Country | US
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Telephone | 504-318-6813
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Fax |
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Provider Business Mailing Address
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Address Line | 900 CAMP ST
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City | NEW ORLEANS
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State | LA
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Zip | 70130-3971
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Country | US
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Telephone | 504-318-6813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7071
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License Number State | LA
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