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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

TYSHAUNDRA RENEE WALLACE M.ED, LCASA, QP
NPI 1669937595
Counselor - Mental Health in High Point, NC

Active since February 05, 2019
1001 PHILLIPS AVE, HIGH POINT, NC 27262(336) 854-2560 Get Directions Write a Review

NPPES record last updated: October 23, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Tyshaundra Renee Wallace M.ed, Lcasa, Qp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYSHAUNDRA RENEE WALLACE M.ED, LCASA, QP (NPI 1669937595) is an individual mental health provider in High Point, North Carolina, licensed in North Carolina (A17585) and active in the NPI registry since February 2019.

NPPES Registry Identity

NPI1669937595
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameTYSHAUNDRA RENEE WALLACECredential: M.ED, LCASA, QP
Location Address1001 PHILLIPS AVEHigh Point, NC 27262-7251
Mailing Address438 Drum Rd Apt 8Reidsville, NC 27320-9062
Phone(336) 854-2560
Sole ProprietorNo
Enumeration DateFebruary 5, 2019
Last NPPES UpdateOctober 23, 2026
NPPES CertifiedOctober 23, 2026
✔ NPI 1669937595 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
Licenses✔ Licensed in NC · A17585✔ Licensed in NC · LCAS-25036
1001 PHILLIPS AVE, High Point, NC 27262
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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. CORTRINA LYNN JOHNSON MSW/LCASA
Counselor (Addiction (Substance Use Disorder))
1001 PHILLIPS AVE
HIGH POINT, NC 27262
Guilford County (910) 670-7119
MS. SARA JEAN RYAN LCSW
Social Worker (Clinical)
1001 PHILLIPS AVE, STE 101
HIGH POINT, NC 27262
Guilford County (336) 841-4307
CARING HANDS HOME HEALTH
Nursing Care
1001 PHILLIPS AVE, SUITE 106
HIGH POINT, NC 27262
Guilford County (336) 883-4586

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 Tyshaundra Wallace's NPI number?

The NPI number for Tyshaundra Wallace is 1669937595. It was assigned to this individual provider in the NPPES registry on February 5, 2019.

Where is Tyshaundra Wallace located?

Tyshaundra Wallace practices at 1001 Phillips Ave, High Point, NC 27262. The listed phone number is (336) 854-2560.

What is Tyshaundra Wallace's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Tyshaundra Wallace was last updated on October 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 days 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.