Provider Demographics
NPI:1851512552
Name:MOORE, DONNA LYN (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MCNEELY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7623
Mailing Address - Country:US
Mailing Address - Phone:919-787-5897
Mailing Address - Fax:919-787-5404
Practice Address - Street 1:5500 MCNEELY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7623
Practice Address - Country:US
Practice Address - Phone:919-787-5897
Practice Address - Fax:919-787-5404
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0048451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106411Medicaid