Provider Demographics
NPI:1457385361
Name:MOORE, NIL A (EDD)
Entity Type:Individual
Prefix:DR
First Name:NIL
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S ELM ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401
Mailing Address - Country:US
Mailing Address - Phone:336-274-2100
Mailing Address - Fax:336-274-6366
Practice Address - Street 1:101 S ELM ST
Practice Address - Street 2:SUITE 325
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-274-2100
Practice Address - Fax:336-274-6366
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2672101YP2500X
NC0833103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107100Medicaid