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General NPI Number Information
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NPI Number | 1487468997
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Entity Type | Individual
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Provider Name | CARLY MOORE
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 311 S EAST ST
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City | CULPEPER
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State | VA
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Zip | 22701-3276
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Country | US
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Telephone | 540-227-0024
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Fax |
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Provider Business Mailing Address
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Address Line | 2033 MEANDER RUN RD
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City | LOCUST DALE
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State | VA
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Zip | 22948-4818
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Country | US
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Telephone | 540-661-7617
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701014465
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License Number State | VA
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