Provider Demographics
NPI:1760625594
Name:OTTE, LEAH BELLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:BELLE
Last Name:OTTE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 RIVER REACH DR W
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8527
Mailing Address - Country:US
Mailing Address - Phone:910-326-7475
Mailing Address - Fax:
Practice Address - Street 1:111 RIVER REACH DR W
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8527
Practice Address - Country:US
Practice Address - Phone:910-326-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0058281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007285Medicaid