Individual provider · Type 1 NPI

Ty'cristian Q. Wallace, LGPC, CAC-ADS

Mental Health Counselor · Baltimore, MD

NPI number 1255053609 Active

Practice location

638 N Gilmor St
Baltimore, MD 21217-2101

Call (410) 462-2268 Map

Mailing address

2902 Dunmore Rd Apt A
Dundalk, MD 21222-5125

Other practice locations

  • 829 Fieldcrest Rd, Cambridge, MD 21613-9423 · (410) 228-8101

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XLGP15614 (MD)
Addiction (Substance Use Disorder) Counselor 101YA0400XAC3232 (MD)

Mental Health Counselor: Definition to come...

7 other providers at this address

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About NPI 1255053609

Ty'cristian Q. Wallace, LGPC, CAC-ADS's National Provider Identifier is 1255053609, issued on Sep 13, 2022. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Baltimore, MD. The record was last updated on Mar 5, 2026.