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General NPI Number Information
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NPI Number | 1083968689
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Entity Type | Individual
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Provider Name | LATANYA RENEE MOORE LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/04/2012
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Last Update Date | 11/04/2012
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Provider Practice Location Address
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Address Line | 3216 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2435
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Country | US
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Telephone | 252-985-3216
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Fax | 252-985-3210
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Provider Business Mailing Address
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Address Line | 3216 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2435
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Country | US
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Telephone | 252-985-3216
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Fax | 252-985-3210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1471
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License Number State | NC
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