Provider Demographics
NPI:1558660829
Name:MOORE, JANICE (MED, LCAS-P)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED, LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 STERLING POINTE DR
Mailing Address - Street 2:UNIT PP9
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3903 STERLING POINTE DR
Practice Address - Street 2:UNIT PP9
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7033
Practice Address - Country:US
Practice Address - Phone:252-258-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health