| Mrs Elaine Marie Wallace, LCPC | |
|
204 Somerset Bay Dr Apt 201, Glen Burnie, MD 21061-6476 | |
| (410) 903-8473 | |
| Not Available |
| Full Name | Mrs Elaine Marie Wallace |
|---|---|
| Gender | Female |
| Speciality | Mental Health Counselor |
| Experience | 5 Years |
| Location | 204 Somerset Bay Dr Apt 201, Glen Burnie, Maryland |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962084574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC13561 (Maryland) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Sondermind Provider Network Llc | 9537572490 | 874 |
| Entity Name | Safe Harbor Behavioral Care Chesapeake Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1295246718 PECOS PAC ID: 0042578171 Enrollment ID: O20171219003042 |
| Entity Name | Sondermind Provider Network Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20210908001372 |
| Mailing Address | Practice Location Address |
|---|---|
| Mrs Elaine Marie Wallace, LCPC 204 Somerset Bay Dr Apt 201, Glen Burnie, MD 21061-6476 Ph: (410) 903-8473 | Mrs Elaine Marie Wallace, LCPC 204 Somerset Bay Dr Apt 201, Glen Burnie, MD 21061-6476 Ph: (410) 903-8473 |
Ms. Leslie A Stanbury, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 122 Langley Road North, Suite B, Glen Burnie, MD 21060 Phone: 410-222-0100 Fax: 410-222-0116 | |
Sharon Clements, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1410 Crain Hwy N, Glen Burnie, MD 21061 Phone: 443-768-7235 | |
Ms. Traci A. Olivier, CSC-AD Counselor Medicare: Not Enrolled in Medicare Practice Location: 122 Langley Road North, Suite B, Glen Burnie, MD 21060 Phone: 410-222-0100 Fax: 410-222-0116 | |
Lissette Wright, Counselor Medicare: Not Enrolled in Medicare Practice Location: 898 Airport Park Rd Ste 101, Glen Burnie, MD 21061 Phone: 443-599-9460 | |
Allison Tate Pastine, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 7401 Ritchie Hwy, Glen Burnie, MD 21061 Phone: 443-250-6653 Fax: 410-740-8068 | |
Tiffany Nicole Huff, ADT Counselor Medicare: Not Enrolled in Medicare Practice Location: 1401 Madison Park Dr, Glen Burnie, MD 21061 Phone: 410-999-0891 | |
Mrs. Karen Ann Rhodes, CSC-AD Counselor Medicare: Not Enrolled in Medicare Practice Location: 1406 Crain Hwy S, Glen Burnie, MD 21061 Phone: 410-766-6624 |