Provider Demographics
NPI:1013405356
Name:MOORE, SAMANTHA TYLER (LPCA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TYLER
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:TYLER
Other - Last Name:ALPIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 GODWIN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3150
Mailing Address - Country:US
Mailing Address - Phone:910-240-2939
Mailing Address - Fax:
Practice Address - Street 1:2003 GODWIN AVE STE C
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3150
Practice Address - Country:US
Practice Address - Phone:910-240-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13926101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013405356Medicaid