Provider Demographics
NPI:1871839845
Name:MOORE-HARDISON, PAMELA MICHELLE (MA, MSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MICHELLE
Last Name:MOORE-HARDISON
Suffix:
Gender:F
Credentials:MA, MSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:M
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MSW
Mailing Address - Street 1:1198 GREY FARM RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27846-9630
Mailing Address - Country:US
Mailing Address - Phone:252-799-1916
Mailing Address - Fax:252-741-9119
Practice Address - Street 1:1198 GREY FARM RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27846
Practice Address - Country:US
Practice Address - Phone:252-741-9119
Practice Address - Fax:252-741-9119
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3185101YA0400X
NC9919101YP2500X
NCC0100461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3185OtherLICENSED CLINCIAL ADDICTION SPECIALIST
NC3185-AOtherLCASA
NCCCS-21001OtherCERTIFIED CLINICAL SUPERVISOR-INTERN
NCS9919OtherLICENSED CLINICAL MENTAL HEALTH COUNSELOR SUPERVISOR (LCMHCS)
NCP008534OtherLCSWA
NC9919OtherLICENSED PROFESSIONAL COUNSELOR
NCC010046OtherLICENSED CLINICAL SOCIAL WORKER
NCA9919OtherLPCA LICENSE NUMBER
NCC010046OtherLICENSED CLINCIAL SOCIAL WORKER