Provider Demographics
NPI:1851501340
Name:MOYE LIVINGSTON, DEENA M (BA)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:M
Last Name:MOYE LIVINGSTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:DEENA
Other - Middle Name:M
Other - Last Name:MOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:3122 PINE CONE TRL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6523
Mailing Address - Country:US
Mailing Address - Phone:336-987-0944
Mailing Address - Fax:
Practice Address - Street 1:3122 PINE CONE TRL
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-6523
Practice Address - Country:US
Practice Address - Phone:336-987-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness