Tyshaundra Renee Wallace, M.Ed, LCASA, QP
Counselor, Mental Health in High Point, NC. Individual provider (NPI-1).
NPI number1669937595
StatusActive
Last updated in NPPESOct 23, 2026
Details
- NPI
- 1669937595
- Entity type
- Individual (NPI-1)
- Name
- Tyshaundra Renee Wallace
- Credential
- M.Ed, LCASA, QP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 5, 2019
- Certification date
- Oct 23, 2026
- Last updated
- Oct 23, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | A17585 | NC | Yes |
| 101YM0800X | Counselor, Mental Health | LCAS-25036 | NC |
Practice location
1001 Phillips AveHigh Point, NC 27262-7251
Phone 336-854-2560
Mailing address
438 Drum Rd Apt 8Reidsville, NC 27320-9062
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