Provider Demographics
NPI:1982808911
Name:MOODY, EDWARD E JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:MOODY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BRADBORNE CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-4508
Mailing Address - Country:US
Mailing Address - Phone:919-359-2797
Mailing Address - Fax:
Practice Address - Street 1:101 BRADBORNE CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-4508
Practice Address - Country:US
Practice Address - Phone:919-359-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085101Y00000X
NC1637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist