Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kimberley R Wallace, LCDC

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1205677150

Kimberley R Wallace, LCDC is an Addiction (Substance Use Disorder) Counselor in Longview, Texas. Practices as a sole proprietor. Licensed in Texas.

Licensed in
TX
In the registry since
2024

Practice location Address checks out

107 Woodbine Pl
Longview, TX 75601-2912
Phone: (903) 758-2471
Fax: (903) 234-1639
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 17017 (TX)

Record details

NPI number1205677150
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCDC
Sole proprietorYes
NPI enumeratedJune 4, 2024
Last updated in NPPESJune 5, 2024
Certification dateJune 5, 2024
Mailing address107 Woodbine Pl, Longview, TX 75601-2912

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