Provider Demographics
NPI:1790576643
Name:MOORE, ABIGAIL
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 POND GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8715
Mailing Address - Country:US
Mailing Address - Phone:513-265-1671
Mailing Address - Fax:
Practice Address - Street 1:3209 GRESHAM LAKE RD STE 113
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4131
Practice Address - Country:US
Practice Address - Phone:919-977-5993
Practice Address - Fax:919-977-8985
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)