Provider Demographics
NPI:1134549439
Name:MOORE, EDITH (LCMHC)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 BENEVENTUM CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9270
Mailing Address - Country:US
Mailing Address - Phone:919-271-0326
Mailing Address - Fax:
Practice Address - Street 1:2101 BENEVENTUM CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-9270
Practice Address - Country:US
Practice Address - Phone:919-271-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8941101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty