Provider Demographics
NPI:1316551096
Name:MOORE, CAROLYNN A (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYNN
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 POORS FORD RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-8488
Mailing Address - Country:US
Mailing Address - Phone:315-276-5773
Mailing Address - Fax:
Practice Address - Street 1:4008 POORS FORD RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-8488
Practice Address - Country:US
Practice Address - Phone:315-276-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0168511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical