Healthcare Provider Details

I. General information

NPI: 1275371940
Provider Name (Legal Business Name): LAWANDA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W PLANK RD
WARSAW NC
28398-1827
US

IV. Provider business mailing address

126 LILLIAN MOORE LN
ROSE HILL NC
28458-8354
US

V. Phone/Fax

Practice location:
  • Phone: 472-472-0170
  • Fax:
Mailing address:
  • Phone: 472-472-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29993
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20862
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: