Provider Demographics
NPI:1811464522
Name:MOORE, LARRY (MHA)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N CHURCH ST APT 1603
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3299
Mailing Address - Country:US
Mailing Address - Phone:330-209-7118
Mailing Address - Fax:
Practice Address - Street 1:620 N CHURCH ST APT 1603
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3299
Practice Address - Country:US
Practice Address - Phone:330-209-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No372600000XNursing Service Related ProvidersAdult Companion