Provider Demographics
NPI:1447568696
Name:MOORE, ANETHIA LACHER
Entity Type:Individual
Prefix:
First Name:ANETHIA
Middle Name:LACHER
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:NC
Mailing Address - Zip Code:28073-8544
Mailing Address - Country:US
Mailing Address - Phone:704-418-8525
Mailing Address - Fax:704-457-4172
Practice Address - Street 1:108 E TIMBERLAND DR
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:NC
Practice Address - Zip Code:28073-8544
Practice Address - Country:US
Practice Address - Phone:704-604-7430
Practice Address - Fax:704-457-4172
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 106H00000X
NCRBT-18-48621106S00000X
NCLCAS-20928101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician