Active NPI
Keisha Moore Speller, MA
- Professional Counselor
- Washington, NC
National Provider Identifier
1083955272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 10072
- Practice address
- 216 Stewart Pkwy
Washington, NC 27889 - Phone
- (252) 946-0585
- Fax
- (252) 946-0580
- NPI assigned
- Mar 13, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3291 | NC | |
| Mental Health Counselor | 101YM0800X | 10072 | NC | |
| Professional Counselor | 101YP2500X | 10072 | NC | Primary |
Addresses
Primary practice location
216 Stewart Pkwy
Washington, NC 27889
Mailing address
111 Cherry St
Williamston, NC 27892-1903
Phone (252) 508-5237
Other practice location 1
223 Washington St
Williamston, NC 27892-2437
Phone (252) 799-3000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10072 | Other | NC | LPC |
| 10072 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10072 | NC | MD | Professional Counselor |
| 3291 | NC | MD | Otolaryngology Physician |
Interoperability endpoints
- dreamprovidercareservicesinc.keishamoorespeller@158148.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530144000000",
"number": "1083955272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 CHERRY ST",
"city": "WILLIAMSTON",
"state": "NC",
"postal_code": "278921903",
"telephone_number": "252-508-5237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 STEWART PKWY",
"city": "WASHINGTON",
"state": "NC",
"postal_code": "27889",
"telephone_number": "252-946-0585",
"fax_number": "252-946-0580"
}
],
"practiceLocations": [
{
"address_1": "223 Washington St",
"address_purpose": "LOCATION",
"city": "Williamston",
"state": "NC",
"postal_code": "278922437",
"country_code": "US",
"telephone_number": "252-799-3000",
"fax_number": "252-792-8104",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SPELLER",
"first_name": "KEISHA",
"middle_name": "MOORE",
"name_prefix": "Mrs.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-13",
"last_updated": "2018-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "3291",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "10072",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "10072",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LPC",
"identifier": "10072",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10072",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.