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

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

Individual provider Mental Health Counselor · NPI 1255053609

Ty'Cristian Q. Wallace, LGPC, CAC-ADS is a Mental Health Counselor in Baltimore, Maryland. Works from 2 locations. Licensed in Maryland.

Licensed in
MD
In the registry since
2022
Specialties on file
2

Practice location Address checks out

638 N Gilmor St
Baltimore, MD 21217-2101
Phone: (410) 462-2268
Show map & directions

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

Additional practice locations (1)

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

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence LGP15614 (MD)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence AC3232 (MD)

Record details

NPI number1255053609
Entity typeIndividual (Type 1)
GenderMale
Credentials LGPC , CAC-ADS
Sole proprietorNo
NPI enumeratedSeptember 13, 2022
Last updated in NPPESMarch 5, 2026
Certification dateMarch 5, 2026

Other providers in Baltimore