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

Maranda Dorothea Wallace, LCMHCA

Individual provider Mental Health Counselor · NPI 1003793761

Maranda Dorothea Wallace, LCMHCA is a Mental Health Counselor in Gastonia, North Carolina. Licensed in North Carolina. Registered with an NPI since 2025.

Licensed in
NC
In the registry since
2025

Practice location Address checks out

1 Roadrunner Dr
Gastonia, NC 28052-6267
Phone: (704) 866-6290
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence A21767 (NC)

Record details

NPI number1003793761
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCMHCA
Sole proprietorNo
NPI enumeratedAugust 16, 2025
Last updated in NPPESJune 18, 2026
Certification dateJune 18, 2026

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