Healthcare Provider Details

I. General information

NPI: 1073431391
Provider Name (Legal Business Name): MOORE TO LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
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: 609-300-4071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA MOORE
Title or Position: OWNER
Credential: LPC, LCADC
Phone: 609-300-4071