Healthcare Provider Details

I. General information

NPI: 1750888038
Provider Name (Legal Business Name): MOORE WAYS TO SUCCESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 4TH ST STE 203G
WINSTON SALEM NC
27101-2782
US

IV. Provider business mailing address

5510 BROOKFIELD RIDGE DR
WINSTON SALEM NC
27105-1757
US

V. Phone/Fax

Practice location:
  • Phone: 336-391-1601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number00282458
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA13571
License Number StateNC

VIII. Authorized Official

Name: MRS. DANIELLE CLARK MOORE
Title or Position: CEO
Credential: CRC, LPCA
Phone: 336-391-1601