Provider Demographics
NPI:1306720289
Name:MOORE, DANIELLE NICOLE (MA, LCMHC-A, LCAS-A)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LCMHC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 SISKEY PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3231
Mailing Address - Country:US
Mailing Address - Phone:908-336-1101
Mailing Address - Fax:
Practice Address - Street 1:3326 SISKEY PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3231
Practice Address - Country:US
Practice Address - Phone:704-443-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21263101YM0800X
NCLCAS-30315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health