MEDICARE: CHERRIA MIA MOORE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1790041416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERRIA MIA MOORE

Provider Business Mailing Address
First Line	:	8025 N POINT BLVD STE 141
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3753
Country	:	US
Telephone Number	:	336-546-5003
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 N POINT BLVD STE 141
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3753
Country	:	US
Telephone Number	:	336-546-5003
Fax Number	:

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

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	07/03/2023

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Directions to “ CHERRIA MIA MOORE ” Practice Location

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