Provider Demographics
NPI:1851055727
Name:MOORE, LAURA NATALIE (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:NATALIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 SALIX BEND DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6081
Mailing Address - Country:US
Mailing Address - Phone:910-309-0997
Mailing Address - Fax:
Practice Address - Street 1:3007 SALIX BEND DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6081
Practice Address - Country:US
Practice Address - Phone:910-309-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health