Provider Demographics
NPI:1649992819
Name:MOORE, LARIN MARIE (LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:LARIN
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E CORPORATION ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2438
Mailing Address - Country:US
Mailing Address - Phone:980-267-0202
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS ST STE 280
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-800-8114
Practice Address - Fax:919-355-5694
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17989101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health