Provider Demographics
NPI:1649925454
Name:MOORE, ALEXANDRA LEIGH (MS, LCMHCA, MT-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LCMHCA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 GUILFORD COLLEGE RD APT K
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2063
Mailing Address - Country:US
Mailing Address - Phone:678-267-4734
Mailing Address - Fax:
Practice Address - Street 1:405 GUILFORD COLLEGE RD APT K
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2063
Practice Address - Country:US
Practice Address - Phone:678-267-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15761225A00000X
NCA16735101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist