MEDICARE: DR. CASSANDRA JO MOORE PHD, MA, LPC, LPC/S

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	5056	SC

General Provider Information

NPI Number	:	1457415853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASSANDRA JO MOORE PHD, MA, LPC, LPC/S

Provider Business Mailing Address
First Line	:	3122 SAVANNAH HWY
Second Line	:
City	:	NORTH
State	:	SC
Zip	:	29112-8165
Country	:	US
Telephone Number	:	803-604-6253
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 SAVANNAH HWY
Second Line	:
City	:	NORTH
State	:	SC
Zip	:	29112-8165
Country	:	US
Telephone Number	:	803-604-6253
Fax Number	:	855-397-9171

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/09/2021

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