Provider Demographics
NPI:1649956434
Name:MOORE, MARCIA S (LCAS-A)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 N. BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27889
Mailing Address - Country:US
Mailing Address - Phone:252-494-2062
Mailing Address - Fax:252-362-0336
Practice Address - Street 1:417 N. BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BLOUNTS CREEK
Practice Address - State:NC
Practice Address - Zip Code:27889
Practice Address - Country:US
Practice Address - Phone:252-494-2062
Practice Address - Fax:252-362-0336
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27879101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)