Provider Demographics
NPI:1750727905
Name:MORAN, CARLY J
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:J
Last Name:MORAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 6TH BAXTER XING # B
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6596
Mailing Address - Country:US
Mailing Address - Phone:832-904-3822
Mailing Address - Fax:
Practice Address - Street 1:502 6TH BAXTER XING # B
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6596
Practice Address - Country:US
Practice Address - Phone:832-904-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst