| Doctor Name: | TEKISHA LEVONNE WALLACE |
| NPI Number: | 1013164490 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 8091 |
| Business Practice Address: | 1236 West Innes St Salisbury, NC - 281444064 |
| Business Phone Number: | 7046333616 |
| Business Fax Number: | |
| Mailing Address: | 284 Executive Park Dr, Suite 100 CONCORD |
| State: | NC |
| Postal Code: | 280251831 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2008 |
| NPI Last Update Date: | 10/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 8091 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |