Provider Demographics
NPI:1205715315
Name:MOREAU, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MOREAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 LATIMER RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5375
Mailing Address - Country:US
Mailing Address - Phone:919-971-3762
Mailing Address - Fax:
Practice Address - Street 1:7406 CHAPEL HILL RD STE H
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5039
Practice Address - Country:US
Practice Address - Phone:919-346-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health