MS. KIMBERLY WALLACE LPC
NPI 1083091987
Counselor - Professional in Marietta, GA
About Ms. Kimberly Wallace Lpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MS. KIMBERLY WALLACE LPC (NPI 1083091987) is an individual professional provider in Marietta, Georgia, licensed in Georgia (LPC008384) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS and is a graduate of Other (2012).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Ms. Kimberly Wallace Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Kimberly Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Marietta, GA 30062
- Reassigned Medicare billing, Georgia enrollment
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
MARIETTA, GA 30062
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 Kimberly Wallace's NPI number?
The NPI number for Kimberly Wallace is 1083091987. It was assigned to this individual provider in the NPPES registry on April 29, 2015.
Where is Kimberly Wallace located?
Kimberly Wallace practices at 2852 Johnson Ferry Rd Ste 100, Marietta, GA 30062. The listed phone number is (404) 906-9831.
What is Kimberly Wallace's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Kimberly Wallace enrolled in Medicare?
Yes. Kimberly Wallace is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Kimberly Wallace's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kimberly Wallace reassigns Medicare benefits to Kimberly Wallace Lpc LLC (Marietta, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kimberly Wallace's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kimberly Wallace was last updated on November 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Ms. Kimberly Wallace, LPC · NPI 1083091987
Professional provider in Marietta, Georgia. Individual provider, active in the CMS NPPES registry since April 29, 2015.
## Identity
- **NPI:** 1083091987 (Entity type: Individual)
- **Enumerated:** April 29, 2015
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** LPC008384 (Georgia)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 2852 JOHNSON FERRY RD STE 100, Marietta, GA 30062-5686
- **Phone:** (404) 906-9831
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Kimberly Wallace Lpc LLC (NPI 1659987238, Marietta, GA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2012
## Record status
- **NPPES last updated:** November 24, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1083091987) · Data from the CMS NPPES public registry.