Provider Demographics
NPI:1629798046
Name:MOORE, NYA (MSW,LCSWA,LCASA)
Entity Type:Individual
Prefix:MS
First Name:NYA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW,LCSWA,LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 YANCEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9646
Mailing Address - Country:US
Mailing Address - Phone:336-314-6148
Mailing Address - Fax:
Practice Address - Street 1:409 PARKWAY ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1623
Practice Address - Country:US
Practice Address - Phone:336-552-4467
Practice Address - Fax:336-612-2338
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0178211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical