Provider Demographics
NPI:1043545577
Name:MOORE, TONYA MICHELLE (MS, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-1083
Mailing Address - Country:US
Mailing Address - Phone:336-291-7477
Mailing Address - Fax:336-760-3674
Practice Address - Street 1:2430 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4626
Practice Address - Country:US
Practice Address - Phone:336-291-7477
Practice Address - Fax:336-291-7477
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional