MEDICARE: MRS. BONITA LUCILLE WALLACE LPC

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	1823	GA

General Provider Information

NPI Number	:	1912364787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONITA LUCILLE WALLACE LPC

Provider Business Mailing Address
First Line	:	550 PHARR RD NE
Second Line	:	SUITE 605
City	:	ATLANTA
State	:	GA
Zip	:	30305-3428
Country	:	US
Telephone Number	:	404-664-6398
Fax Number	:	678-705-2758

Provider Business Practice Location Address
First Line	:	550 PHARR RD NE
Second Line	:	SUITE 605
City	:	ATLANTA
State	:	GA
Zip	:	30305-3428
Country	:	US
Telephone Number	:	404-664-6398
Fax Number	:	678-705-2758

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

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	01/25/2016

Similar Medicare Providers

1518455666 — NNENNA OKOR AKARONU MD
Practice Location Address:

550 PHARR RD NE
ATLANTA, GA
30305-3428

Practice Phone: 404-235-5982
Practice Fax: 678-705-2756

1063471324 — PEACHTREE ORAL & MAXILLOFACIAL SURGERY ASSOCIATES
Practice Location Address:

550 PHARR RD NE , SUITE 325
ATLANTA, GA
30305-3428

Practice Phone: 404-233-8221
Practice Fax: 404-233-5783

1386780369 — VALERIE S. MARLER PH.D.,P.C.
Practice Location Address:

550 PHARR RD NE , SUITE 205
ATLANTA, GA
30305-3428

Practice Phone: 404-237-3492
Practice Fax: 404-237-0442

1932223740 — DR. GREGORY PAUL MARKS D.D.S.
Practice Location Address:

550 PHARR RD NE , SUITE 325
ATLANTA, GA
30305-3428

Practice Phone: 404-233-8221
Practice Fax: 404-233-5783

1083873640 — DR. MICHAEL MCHANEY DEMO DDS
Practice Location Address:

550 PHARR RD NE , SUITE 325
ATLANTA, GA
30305-3428

Practice Phone: 404-233-8221
Practice Fax: 404-233-5783

1528369964 — VALERIE S MARLER,PH.D.,P.C.
Practice Location Address:

550 PHARR RD NE , SUITE 205
ATLANTA, GA
30305-3428

Practice Phone: 404-237-3492
Practice Fax: 404-237-0442

Directions to “ MRS. BONITA LUCILLE WALLACE LPC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.