Provider Demographics
NPI:1497385595
Name:MOORE, AEREIL (MS, LCMHC, LCAS)
Entity type:Individual
Prefix:MRS
First Name:AEREIL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LCMHC, LCAS
Other - Prefix:MS
Other - First Name:AEREIL
Other - Middle Name:
Other - Last Name:PEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCMHC, LCAS
Mailing Address - Street 1:PO BOX 748465
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8465
Mailing Address - Country:US
Mailing Address - Phone:855-284-7483
Mailing Address - Fax:
Practice Address - Street 1:4324 WALLBURG LANDING DR APT 204
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-7211
Practice Address - Country:US
Practice Address - Phone:336-813-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25198101YA0400X
NC14537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)