Active NPI
Robert Lee Wallace, LPC
- Counselor
- Rockingham, NC
National Provider Identifier
1154582773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 4253
- Practice address
- 110 S Hancock St
Rockingham, NC 28379-3675 - Phone
- (910) 997-9240
- NPI assigned
- Jun 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 4253 | NC | Primary |
Addresses
Primary practice location
110 S Hancock St
Rockingham, NC 28379-3675
Mailing address
110 S Hancock St
Rockingham, NC 28379-3675
Phone (910) 997-9240
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4253 | NC | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213660800000",
"number": "1154582773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 S HANCOCK ST",
"city": "ROCKINGHAM",
"state": "NC",
"postal_code": "283793675",
"telephone_number": "910-997-9240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 S HANCOCK ST",
"city": "ROCKINGHAM",
"state": "NC",
"postal_code": "283793675",
"telephone_number": "910-997-9240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ROBERT",
"middle_name": "LEE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-17",
"last_updated": "2008-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "4253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockingham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.