Individual
NICHOLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3511 W MARKET ST, STE. B, GREENSBORO, NC 27403-4443
(336) 294-3338
(336) 294-6696
Mailing address
604 PEACH ORCHARD DR, BROWNS SUMMIT, NC 27214-9498
(336) 543-4381
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300082K
—
NC
Enumeration date
10/09/2012
Last updated
10/09/2012
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