Individual provider Active NPI

Ellena Vanessa Rubinstein, LCMHC

  • Mental Health Counselor
  • Clemmons, NC
National Provider Identifier
1760808208
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
19244 Issued in NC
Practice address
2235 Lewisville Clemmons Rd Ste a
Clemmons, NC 27012-9342
Phone
(336) 722-7266
Fax
(336) 201-0538
NPI assigned
Mar 7, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 5600 SC
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 19244 NC Primary

Addresses

Primary practice location

2235 Lewisville Clemmons Rd Ste a
Clemmons, NC 27012-9342

Mailing address

713 S Marshall St
Winston Salem, NC 27101-5808
Phone (336) 722-7266

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

LicenseStateTypeSpecialty
19244NCMDMental Health Counselor
5600SCMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mood Treatment Center, PLLC Single Specialty CurrentSince Oct 8, 2023 Accepting new patients
Complete Care Partners LLC Single Specialty PastSince Oct 8, 2023 Accepting new patients

Locations

2235 Lewisville Clemmons Rd
Ste A
Clemmons, NC 27012
Phone (336) 408-6917

713 S Marshall St
Winston Salem, NC 27101
Phone (336) 831-3738

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1760808208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 S MARSHALL ST",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271015808",
            "telephone_number": "336-722-7266",
            "fax_number": "336-201-0538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 LEWISVILLE CLEMMONS RD STE A",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129342",
            "telephone_number": "336-722-7266",
            "fax_number": "336-201-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBINSTEIN",
        "first_name": "ELLENA",
        "middle_name": "VANESSA",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-07",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "SC",
            "license": "5600",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "19244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.