Healthcare Provider Details

I. General information

NPI: 1649925454
Provider Name (Legal Business Name): ALEXANDRA LEIGH MOORE MS, LCMHCA, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 GUILFORD COLLEGE RD APT K
GREENSBORO NC
27409-2063
US

IV. Provider business mailing address

405 GUILFORD COLLEGE RD APT K
GREENSBORO NC
27409-2063
US

V. Phone/Fax

Practice location:
  • Phone: 678-267-4734
  • Fax:
Mailing address:
  • Phone: 678-267-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA16735
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number15761
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: