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General NPI Number Information
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NPI Number | 1205658242
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Entity Type | Individual
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Provider Name | BALIQIS OLAWALE-MOORE LCSWA
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 312 W MILLBROOK RD STE 129
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City | RALEIGH
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State | NC
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Zip | 27609-4398
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Country | US
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Telephone | 919-877-6101
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 1 BOX 5607
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City | APO
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State | AE
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Zip | 09009-0057
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P020924
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License Number State | NC
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