Provider Demographics
NPI:1114181351
Name:MOORE, STEVEN CHARLES (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:CHARLES
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HANSKA CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8604
Mailing Address - Country:US
Mailing Address - Phone:703-405-9895
Mailing Address - Fax:
Practice Address - Street 1:4 HANSKA CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8604
Practice Address - Country:US
Practice Address - Phone:703-405-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06294101YM0800X
NCC008798101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health