Active NPI
Rebecca Morrison Otallah, LPC
- Professional Counselor
- Winston Salem, NC
National Provider Identifier
1689094187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 13666
- Practice address
- 648 E Monmouth St
Winston Salem, NC 27107-3227 - Phone
- (336) 718-4360
- Fax
- (336) 718-4369
- NPI assigned
- Apr 23, 2014
- Last updated
- Mar 4, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701005782 | VA | |
| Professional Counselor | 101YP2500X | 13666 | NC | Primary |
Addresses
Primary practice location
648 E Monmouth St
Winston Salem, NC 27107-3227
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Other practice location 1
1285 Swan Lake Dr Apt 404
Charlottesville, VA 22902-8217
Phone (540) 908-8467
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rotallah540228@direct.novanthealth.org |
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 |
|---|---|---|---|
| 0701005782 | VA | MD | Professional Counselor |
| 13666 | NC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614816000000",
"number": "1689094187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751803",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "648 E MONMOUTH ST",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271073227",
"telephone_number": "336-718-4360",
"fax_number": "336-718-4369"
}
],
"practiceLocations": [
{
"address_1": "1285 Swan Lake Dr Apt 404",
"address_purpose": "LOCATION",
"city": "Charlottesville",
"state": "VA",
"postal_code": "229028217",
"country_code": "US",
"telephone_number": "540-908-8467",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OTALLAH",
"first_name": "REBECCA",
"middle_name": "MORRISON",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-23",
"last_updated": "2021-03-04",
"certification_date": "2021-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701005782",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "13666",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rotallah540228@direct.novanthealth.org",
"affiliation": "N",
"address_1": "1285 Swan Lake Dr Apt 404",
"city": "Charlottesville",
"state": "VA",
"country_code": "US",
"postal_code": "229028217",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.