Individual provider · Type 1 NPI
Miata Quintae Wallace, MS
Counselor · Chesapeake, VA
NPI number
1710855838
Active
Practice location
1524 Volvo Pkwy Ste B
Chesapeake, VA 23320-1516
Mailing address
957 Duck Pond Dr Apt 301
Virginia Beach, VA 23464-3340
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor Primary | 101Y00000X | None listed |
Counselor: A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
4 other providers at this address
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About NPI 1710855838
Miata Quintae Wallace, MS's National Provider Identifier is 1710855838, issued on Oct 29, 2025. The primary taxonomy on file is Counselor (101Y00000X), and the practice location is in Chesapeake, VA. The record was last updated on Oct 29, 2025.