Provider Demographics
NPI:1821797572
Name:MOORE, MARY AUSTIN (MS, CRC, LCMHCA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AUSTIN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, CRC, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 FINWICK DR
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-9043
Mailing Address - Country:US
Mailing Address - Phone:336-692-3545
Mailing Address - Fax:
Practice Address - Street 1:153 JEFFERSON CHURCH RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8605
Practice Address - Country:US
Practice Address - Phone:336-692-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health