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1255736153 NPI number — SONYA GLYN MOORE M.S. , LADAC II

NPI Number: 1255736153
Health Care Provider/Practitioner: SONYA GLYN MOORE M.S. , LADAC II

Information about “1255736153” NPI (SONYA GLYN MOORE M.S. , LADAC II) exists in 1255736153 in HTML format HTML  |  1255736153 in plain Text format TXT  |  1255736153 in PDF (Portable Document Format) PDF  |  1255736153 in an XML format XML  formats.

NPI Number : 1255736153 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255736153",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOORE",
    "FirstName": "SONYA",
    "MiddleName": "GLYN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S. , LADAC II",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4845 W ANDREW JOHNSON HWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MORRISTOWN",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37814-1023",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "828-335-2310",
    "MailingAddressFaxNumber": "423-266-5101",
    "FirstLinePracticeLocationAddress": "400 W 1ST NORTH ST STE D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MORRISTOWN",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37814-4617",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "828-335-2310",
    "PracticeLocationAddressFaxNumber": "423-266-5101",
    "EnumerationDate": "11/04/2014",
    "LastUpdateDate": "04/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC1900X",
          "TaxonomyName": "Counseling Psychologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Psychologist",
          "LicenseNumber": "LDC0000001260",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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