Healthcare Provider Details

I. General information

NPI: 1033374350
Provider Name (Legal Business Name): PAMELA SIOBOHN MOYE L.C.A.S., M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 REVOLUTION MILL DR SUITE 11
GREENSBORO NC
27405-5065
US

IV. Provider business mailing address

1150 REVOLUTION MILL DR SUITE 11
GREENSBORO NC
27405-5065
US

V. Phone/Fax

Practice location:
  • Phone: 336-457-2355
  • Fax:
Mailing address:
  • Phone: 336-457-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number540
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: