Provider Demographics
NPI:1154929552
Name:MOORE, KAITLYN LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-7927
Mailing Address - Country:US
Mailing Address - Phone:828-452-1395
Mailing Address - Fax:
Practice Address - Street 1:91 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-7927
Practice Address - Country:US
Practice Address - Phone:828-452-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153441041C0700X
NCC0156441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical