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NPI Code Detail

MEDICARE: ANGELA MOORE M.ED, BCBA

MEDICARE: ANGELA MOORE M.ED, BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1992128003
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA MOORE M.ED, BCBA
Provider Business Mailing Address
First Line : 1407 GORDON RD
Second Line :
City : ROCK HILL
State : SC
Zip : 29732-9712
Country : US
Telephone Number : 904-887-8930
Fax Number :
Provider Business Practice Location Address
First Line : 420 HAWTHORNE LN
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2312
Country : US
Telephone Number : 904-887-8930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2014
Last Update Date : 12/27/2021

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