Provider Demographics
NPI:1093564890
Name:MOON, LAUREN (MS, NCC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MOON
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4854 WEATHERHILL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4377
Mailing Address - Country:US
Mailing Address - Phone:302-650-6679
Mailing Address - Fax:
Practice Address - Street 1:4854 WEATHERHILL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4377
Practice Address - Country:US
Practice Address - Phone:302-533-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional