Doctor Name: | JOHN DAVID MOORE |
NPI Number: | 1639369556 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | 9119 |
Business Practice Address: | 2514 S Croatan Hwy Nags Head, NC - 279599016 |
Business Phone Number: | 1406750417 |
Business Fax Number: | |
Mailing Address: | 2514 S Croatan Hwy, NAGS HEAD |
State: | NC |
Postal Code: | 279599016 |
Phone Number: | 1406750417 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2007 |
NPI Last Update Date: | 02/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 9119 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |