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General NPI Number Information
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NPI Number | 1619632924
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Entity Type | Organization
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Legal Business Name | A.C. MOORE USA CO., L.L.C.
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 03/05/2023
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Provider Practice Location Address
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Address Line | 172 TOWN HILL RD STE 5
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City | LOUISA
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State | KY
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Zip | 41230-6389
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Country | US
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Telephone | 606-471-9423
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX # 3
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City | LOUISA
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State | KY
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Zip | 41230-0003
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Country | US
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Telephone | 606-471-9423
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ALEX C MOORE
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Credential | CEO
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Telephone | 606-471-9423
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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 |
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License Number State |
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