JENNIFER WALLACE MS, LPC, RPT
NPI 1013389113
Counselor - Professional in Cumming, GA
About Jennifer Wallace Ms, Lpc, Rpt NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JENNIFER WALLACE MS, LPC, RPT (NPI 1013389113) is an individual professional provider in Cumming, Georgia, licensed in Georgia (LPC007671) and active in the NPI registry since October 2015. She has opted out of Medicare through March 7, 2028.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Jennifer Wallace Ms, Lpc, Rpt has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 7, 2024 through March 7, 2028.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
CUMMING, GA 30040
CUMMING, GA 30040
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jennifer Wallace's NPI number?
The NPI number for Jennifer Wallace is 1013389113. It was assigned to this individual provider in the NPPES registry on October 28, 2015.
Where is Jennifer Wallace located?
Jennifer Wallace practices at 110 Samaritan Dr Suite 110, Cumming, GA 30040. The listed phone number is (888) 850-4891.
What is Jennifer Wallace's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Jennifer Wallace enrolled in Medicare?
No. Jennifer Wallace has opted out of Medicare through March 7, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.
When was this NPI record last updated?
The NPPES record for Jennifer Wallace was last updated on October 28, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jennifer Wallace, MS, LPC, RPT · NPI 1013389113
Professional provider in Cumming, Georgia. Individual provider, active in the CMS NPPES registry since October 28, 2015.
## Identity
- **NPI:** 1013389113 (Entity type: Individual)
- **Enumerated:** October 28, 2015
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** LPC007671 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 110 SAMARITAN DR, SUITE 110, Cumming, GA 30040-2535
- **Phone:** (888) 850-4891
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through March 7, 2028); services are provided under private contract
## Record status
- **NPPES last updated:** October 28, 2015
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Source: [NPI Profile](https://npiprofile.com/npi/1013389113) · Data from the CMS NPPES public registry.