Healthcare Provider Details

I. General information

NPI: 1629908389
Provider Name (Legal Business Name): ANNA ROSE MOORING LCMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3817 BUCKLIN DR N
ELM CITY NC
27822-9292
US

IV. Provider business mailing address

3817 BUCKLIN DR N
ELM CITY NC
27822-9292
US

V. Phone/Fax

Practice location:
  • Phone: 910-990-1997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21678
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: