1871839845 NPI number — PAMELA MICHELLE MOORE-HARDISON MA, MSW

Table of content: PAMELA MICHELLE MOORE-HARDISON MA, MSW (NPI 1871839845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871839845 NPI number — PAMELA MICHELLE MOORE-HARDISON MA, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE-HARDISON
Provider First Name:
PAMELA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOORE
Provider Other First Name:
PAMELA
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, MSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871839845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1198 GREY FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27846-9630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-799-1916
Provider Business Mailing Address Fax Number:
252-741-9119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1198 GREY FARM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-741-9119
Provider Business Practice Location Address Fax Number:
252-741-9119
Provider Enumeration Date:
12/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  3185 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 9919 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: C010046 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3185 . This is a "LICENSED CLINCIAL ADDICTION SPECIALIST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3185-A . This is a "LCASA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CCS-21001 . This is a "CERTIFIED CLINICAL SUPERVISOR-INTERN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: S9919 . This is a "LICENSED CLINICAL MENTAL HEALTH COUNSELOR SUPERVISOR (LCMHCS)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P008534 . This is a "LCSWA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9919 . This is a "LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C010046 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A9919 . This is a "LPCA LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C010046 . This is a "LICENSED CLINCIAL SOCIAL WORKER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com