Provider Demographics
NPI:1871211599
Name:MOORE, TAMARA ROCHELLE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ROCHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 DORIAN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7264
Mailing Address - Country:US
Mailing Address - Phone:910-336-2941
Mailing Address - Fax:
Practice Address - Street 1:401 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5635
Practice Address - Country:US
Practice Address - Phone:910-321-0069
Practice Address - Fax:910-491-1000
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0181571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical