Provider Demographics
NPI:1417373580
Name:MOORE, TORY (LCSWA)
Entity Type:Individual
Prefix:
First Name:TORY
Middle Name:
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 1:104 KEMPWOOD DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9627
Mailing Address - Country:US
Mailing Address - Phone:919-368-8597
Mailing Address - Fax:
Practice Address - Street 1:104 KEMPWOOD DR APT 2B
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-9627
Practice Address - Country:US
Practice Address - Phone:919-368-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP1040501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical