Provider Demographics
NPI:1356683148
Name:MOORE, ALICIA SHEREESE (LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:SHEREESE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:SHEREESE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-A
Mailing Address - Street 1:9027 GROUSE RUN LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9027 GROUSE RUN LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6120
Practice Address - Country:US
Practice Address - Phone:910-717-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2745101YA0400X
NCS9863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)