MEDICARE: MRS. KATHLEEN JULIA MOYER LPCA

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	A13624	NC

General Provider Information

NPI Number	:	1568963957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN JULIA MOYER LPCA

Provider Business Mailing Address
First Line	:	1601 JONES FRANKLIN RD STE 104
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3379
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 FAST PARK DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4853
Country	:	US
Telephone Number	:	919-851-1527
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	02/22/2018

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