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General NPI Number Information
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NPI Number | 1144942343
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Entity Type | Individual
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Provider Name | REBECCA CAROLYN OTWELL-DOVE PHD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 115 HABERSHAM DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7353
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Country | US
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Telephone | 770-461-9944
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Fax |
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Provider Business Mailing Address
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Address Line | 115 HABERSHAM DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7353
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Country | US
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Telephone | 770-461-9944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS-T001186
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License Number State | GA
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