Provider Demographics
NPI:1588292973
Name:MOORE, BRITTANY (EDS, HHC, NCSP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:EDS, HHC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 INDEPENDENCE PLACE DR APT 1336
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-0229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:143 SKATEWAY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2640
Practice Address - Country:US
Practice Address - Phone:910-864-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA47172103TS0200X
171M00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275172298Medicaid