Individual
MR. JASON MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 N MAIN ST # 200, LOUISBURG, NC 27549-2516
(919) 496-7781
Mailing address
3533 CASTLEFIELD LN, FAYETTEVILLE, NC 28306-9677
(910) 431-0197
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-22354
NC
Other
Enumeration date
02/22/2017
Last updated
02/22/2017
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