Provider Demographics
NPI:1164287793
Name:WALLACE, BARBARA (LICSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2409
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2409
Mailing Address - Country:US
Mailing Address - Phone:256-536-4700
Mailing Address - Fax:
Practice Address - Street 1:415 CHURCH ST NW STE 10
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5573
Practice Address - Country:US
Practice Address - Phone:256-536-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLICSW5597C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health