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General NPI Number Information
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NPI Number | 1376059840
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Entity Type | Individual
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Provider Name | DANIELLE CLARK MOORE MS, CRC, LPCA
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Gender | Female
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 500 W 4TH ST STE 203
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City | WINSTON SALEM
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State | NC
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Zip | 27101-2782
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Country | US
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Telephone | 336-391-1601
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Fax |
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Provider Business Mailing Address
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Address Line | 5510 BROOKFIELD RIDGE DR
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City | WINSTON SALEM
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State | NC
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Zip | 27105-1757
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Country | US
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Telephone | 336-391-1601
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A13571
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00282458
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License Number State | NC
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