MEDICARE: REACH THE MOONE PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1689524068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACH THE MOONE PLLC

Provider Business Mailing Address
First Line	:	227 W 4TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1545
Country	:	US
Telephone Number	:	704-774-3910
Fax Number	:

Provider Business Practice Location Address
First Line	:	6206 SPANISH MOSS LANE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262
Country	:	US
Telephone Number	:	704-774-3910
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	ARIEL MARTIN
Credential	:
Telephone Number	:	704-774-3910

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “REACH THE MOONE PLLC ” Practice Location

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