Healthcare Provider Details

I. General information

NPI: 1316678642
Provider Name (Legal Business Name): JESSICA L MOORE LPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 CRESTWOOD DR
FORKED RIVER NJ
08731-3841
US

IV. Provider business mailing address

2033 CRESTWOOD DR
FORKED RIVER NJ
08731-3841
US

V. Phone/Fax

Practice location:
  • Phone: 848-234-1631
  • Fax:
Mailing address:
  • Phone: 609-300-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01277100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00420600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: