Provider Demographics
NPI:1609923606
Name:MOORE, CINDY S (MAHSP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:MAHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 OAKMONT DR
Mailing Address - Street 2:STE 2 AND 3
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-321-1570
Mailing Address - Fax:252-321-6528
Practice Address - Street 1:103 OAKMONT DR
Practice Address - Street 2:STE 2 AND 3
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-321-1570
Practice Address - Fax:252-321-6528
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
562165173OtherFED IDENTIFICATION NUMBER
NC144M7OtherBCBS