Provider Demographics
NPI:1528432564
Name:MOORE, MONIKA SHEREE (MSW LCASA)
Entity type:Individual
Prefix:MISS
First Name:MONIKA
Middle Name:SHEREE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW LCASA
Other - Prefix:MISS
Other - First Name:LAKITA
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QP
Mailing Address - Street 1:3205 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-2866
Mailing Address - Country:US
Mailing Address - Phone:704-367-7447
Mailing Address - Fax:
Practice Address - Street 1:3205 FREEDOM DR,
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208
Practice Address - Country:US
Practice Address - Phone:704-315-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10076101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)