Individual
TRACY J MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
5500 EXECUTIVE CENTER DR, CHARLOTTE, NC 28212-8856
(704) 537-5760
Mailing address
5500 EXECUTIVE CENTER DR, CHARLOTTE, NC 28212-8856
(704) 537-5760
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LCAS-15519
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-15519
NC
101YM0800X
Mental Health Counselor
LCAS-15519
NC
1041C0700X
Clinical Social Worker
P007403
NC
171M00000X
Case Manager/Care Coordinator
LCAS-15519
NC
172V00000X
Community Health Worker
LCAS-15519
NC
Other
Enumeration date
10/26/2012
Last updated
09/28/2016
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