Individual
MRS. JENNIFER PRUITT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
524 SIGNAL HILL DRIVE EXT, STATESVILLE, NC 28625-4391
(704) 871-1045
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5257
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184631582
—
NC
05
—
6103396
—
NC
05
—
PC1484
—
SC
Enumeration date
08/01/2006
Last updated
08/11/2017
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