Provider Demographics
NPI:1255936092
Name:MOORE, MORGAN LEANNE
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 NC HIGHWAY 96 S
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-7056
Mailing Address - Country:US
Mailing Address - Phone:910-890-6212
Mailing Address - Fax:
Practice Address - Street 1:317 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-9626
Practice Address - Country:US
Practice Address - Phone:910-249-4219
Practice Address - Fax:866-279-1991
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26936101YA0400X
NCC0157041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)