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Individual

GLORIA DIANNE MOON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPA

Contact information

Practice address
380 COPPERFIELD BLVD NE, NE PSYCHIATRIC & PSYCHOLOGICAL INST, CONCORD, NC 28025-2402
(704) 262-1800
(704) 262-1836
Mailing address
380 COPPERFIELD BLVD NE, NE PSYCHIATRIC & PSYCHOLOGICAL INST, CONCORD, NC 28025-2402
(704) 262-1800
(704) 262-1836

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2089
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
137PE
BCBS PROV ID
NC
05
6107201
NC
Enumeration date
05/31/2006
Last updated
07/09/2007
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