MEDICARE: MRS. TONYA MICHELLE MOORE MS, NCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	7433	NC

General Provider Information

NPI Number	:	1043545577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA MICHELLE MOORE MS, NCC, LPC

Provider Business Mailing Address
First Line	:	PO BOX 1083
Second Line	:
City	:	LEWISVILLE
State	:	NC
Zip	:	27023-1083
Country	:	US
Telephone Number	:	336-291-7477
Fax Number	:	336-760-3674

Provider Business Practice Location Address
First Line	:	2430 REYNOLDA RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-4626
Country	:	US
Telephone Number	:	336-291-7477
Fax Number	:	336-291-7477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2009
Last Update Date	:	08/06/2022

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