Provider Demographics
NPI:1679284400
Name:MOORE, CHRISTA JANE (PHD, CCS, LCSWA)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:JANE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, CCS, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHRISTA MOORE
Mailing Address - Street 2:CENTER FOR EMOTIONAL HEALTH
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293
Mailing Address - Country:US
Mailing Address - Phone:276-455-0842
Mailing Address - Fax:
Practice Address - Street 1:280 EXECUTIVE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1838
Practice Address - Country:US
Practice Address - Phone:276-455-0842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0185071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP018507OtherLCSWA