Provider Information for 1639369556
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JOHN DAVID MOORE II LCPC
Sex: Male
NPI: 1639369556
Last Updated: 2012-02-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639369556 | ||||||||||||
| Enumeration Date | 2007-07-26 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2514 S CROATAN HWY NAGS HEAD, NC 27959-9016 United States Phone: 140-675-0417 | Fax: | ||||||||||||
| Primary Practice Address | 2514 S CROATAN HWY NAGS HEAD, NC 27959-9016 United States Phone: 140-675-0417 | Fax: | ||||||||||||
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