Provider Demographics
NPI:1861876914
Name:J. DEMOOY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:J. DEMOOY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEMOOY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:252-305-9405
Mailing Address - Street 1:7531 S VIRGINIA DARE TRL
Mailing Address - Street 2:2B
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-9441
Mailing Address - Country:US
Mailing Address - Phone:252-305-9405
Mailing Address - Fax:
Practice Address - Street 1:207 QUEEN ELIZABETH AVE
Practice Address - Street 2:#28
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9282
Practice Address - Country:US
Practice Address - Phone:270-519-1806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J. DEMOOY COUNSELING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-17
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0054461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty