Healthcare Provider Details

I. General information

NPI: 1972059541
Provider Name (Legal Business Name): MOXIE DBT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W. MAIN ST. SUITE C
CARRBORO NC
27510-2082
US

IV. Provider business mailing address

212 W MAIN ST SUITE C
CARRBORO NC
27510-2082
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-3847
  • Fax: 800-539-5048
Mailing address:
  • Phone: 919-622-3847
  • Fax: 800-539-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004453
License Number StateNC

VIII. Authorized Official

Name: CHARLEEN ENNS
Title or Position: OWNER
Credential: LCSW
Phone: 919-622-3847