Provider Demographics
NPI:1881806958
Name:MOORE, TAMMIE DUCRE (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:DUCRE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 E CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3459
Mailing Address - Country:US
Mailing Address - Phone:919-467-3831
Mailing Address - Fax:919-467-1611
Practice Address - Street 1:232 E CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3459
Practice Address - Country:US
Practice Address - Phone:919-467-3831
Practice Address - Fax:919-467-1611
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TC1900X
NC2878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCTMOORE32Medicaid
NC045XHOtherBLUE CROSS BLUE SHIELD