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General NPI Number Information
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NPI Number | 1972059541
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Entity Type | Organization
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Legal Business Name | MOXIE DBT, PLLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 212 W. MAIN ST. SUITE C
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City | CARRBORO
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State | NC
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Zip | 27510-2082
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Country | US
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Telephone | 919-622-3847
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Fax | 800-539-5048
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Provider Business Mailing Address
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Address Line | 212 W MAIN ST SUITE C
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City | CARRBORO
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State | NC
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Zip | 27510-2082
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Country | US
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Telephone | 919-622-3847
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Fax | 800-539-5048
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Authorized Official
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Title or Position | OWNER
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Name | CHARLEEN ENNS
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Credential | LCSW
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Telephone | 919-622-3847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C004453
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License Number State | NC
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