Provider Demographics
NPI:1063296911
Name:MORAN, EMILY J (PHD, LCSWA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:MORAN
Suffix:
Gender:F
Credentials:PHD, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 E ROCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7242
Mailing Address - Country:US
Mailing Address - Phone:336-327-0678
Mailing Address - Fax:
Practice Address - Street 1:701 W MAIN ST STE FG
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-8836
Practice Address - Country:US
Practice Address - Phone:336-542-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical