Healthcare Provider Details

I. General information

NPI: 1467663013
Provider Name (Legal Business Name): WESLEY JAY MOONE L.P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 MONROE RD SUITE 203
CHARLOTTE NC
28212-5503
US

IV. Provider business mailing address

5509 MONROE RD SUITE 203
CHARLOTTE NC
28212-5503
US

V. Phone/Fax

Practice location:
  • Phone: 704-535-4143
  • Fax: 704-568-8927
Mailing address:
  • Phone: 704-535-4143
  • Fax: 704-568-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1437
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: