Healthcare Provider Details

I. General information

NPI: 1922389444
Provider Name (Legal Business Name): REBECCA ODELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 AVIEMORE DR
PINEHURST NC
28374-9797
US

IV. Provider business mailing address

115 SHEPHERDS MEADOW WAY UNIT 305
MOORESVILLE NC
28115-0396
US

V. Phone/Fax

Practice location:
  • Phone: 910-235-3139
  • Fax:
Mailing address:
  • Phone: 910-465-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10667
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: