Provider Demographics
NPI:1649039439
Name:MOORE, LA KEVIA NADINE (EDD, LCSWA)
Entity type:Individual
Prefix:DR
First Name:LA KEVIA
Middle Name:NADINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:EDD, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 REGENCY COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8679
Mailing Address - Country:US
Mailing Address - Phone:919-538-9718
Mailing Address - Fax:
Practice Address - Street 1:933 REGENCY COTTAGE PL
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8679
Practice Address - Country:US
Practice Address - Phone:919-538-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical