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General NPI Number Information
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NPI Number | 1790576643
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Entity Type | Individual
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Provider Name | ABIGAIL MOORE
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 3209 GRESHAM LAKE RD STE 113
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City | RALEIGH
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State | NC
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Zip | 27615-4131
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Country | US
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Telephone | 919-977-5993
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Fax | 919-977-8985
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Provider Business Mailing Address
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Address Line | 1535 POND GLEN WAY
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City | CARY
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State | NC
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Zip | 27519-8715
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Country | US
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Telephone | 513-265-1671
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAS-30619
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License Number State | NC
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