Provider Demographics
NPI:1093797110
Name:MOORE-MCNEIL, CARLA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:RAE
Last Name:MOORE-MCNEIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14770
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4770
Mailing Address - Country:US
Mailing Address - Phone:336-430-6314
Mailing Address - Fax:336-285-0315
Practice Address - Street 1:502 E CORNWALLIS DR STE N
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5677
Practice Address - Country:US
Practice Address - Phone:336-430-6314
Practice Address - Fax:336-285-0315
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0040681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002588Medicaid