Individual
MRS. DORIS ANN MOORE-RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
111 LAMON ST, SUITE 212, FAYETTEVILLE, NC 28301-4957
(910) 429-2222
(910) 429-2222
Mailing address
6208 KING HIRAM RD, HOPE MILLS, NC 28348-9767
(910) 429-0543
(910) 429-0543
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C004369
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136AJ
BC/BS OF NORTH CAROLINA
NC
01
—
365036
MANAGED HEALTH NETWORK
NC
01
—
522556
VALUE OPTIONS
NC
05
—
6002914
—
NC
Enumeration date
10/27/2005
Last updated
07/08/2007
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