Individual
JOHN DAVID MOORE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
2514 S CROATAN HWY, NAGS HEAD, NC 27959-9016
(140) 675-0417
Mailing address
2514 S CROATAN HWY, NAGS HEAD, NC 27959-9016
(140) 675-0417
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
9119
NC
101YP2500X
Professional Counselor
Primary
1326 LCPC
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000744050
BLUE CROSS-SHIELD PROV #
MT
05
—
1639369556
—
NC
Enumeration date
07/26/2007
Last updated
02/29/2012
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