Provider Demographics
NPI:1790955656
Name:MOORE, SARAH ALYCE (LPC, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ALYCE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, LPC-S
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:MOORE
Other - Last Name:BROOKSHIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LPC-S
Mailing Address - Street 1:350 PEE DEE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4932
Mailing Address - Country:US
Mailing Address - Phone:704-986-1500
Mailing Address - Fax:
Practice Address - Street 1:350 PEE DEE AVE STE A
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4932
Practice Address - Country:US
Practice Address - Phone:704-986-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional