MARY LISA MOORE (NPI# 1386743649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386743649 |
| Entity Type | Individual |
| Full Name | MARY LISA MOORE |
| Practice Address |
2905 Breezewood Ave Suite 101 Fayetteville NC 28303 |
| Mailing Address |
1415 West Hwy 54 Suite 101 Durham NC 27707 |
| Practice Telephone | 9102239927 |
| Mailing Telephone | 9194020120 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
5216 | NC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6103180 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780215467 | Mary Major Moore | Massage Therapist | 335 Ne 4th St # Dt, Bend, OR 97701-5162 | 2020-01-30 |
| 1205205804 | Mary Rose Moore | Nurse Practitioner | 1443 Richmond Road, Lyndhurst, OH 44124 | 2015-09-24 |
| 1063654192 | Mary G Moore | Counselor | 103 William Dr, Normal, IL 61761-1862 | 2009-04-06 |
| 1588812325 | Mary Moore | Occupational Therapist | 6801 Copra Ln, Louisville, KY 40219-2156 | 2008-09-05 |
| 1275796625 | Mary Moore | Advanced Practice Midwife | 4118 Winnemac Ave, Madison, WI 53711-1645 | 2008-07-07 |
| 1023288123 | Mary Elizabeth Moore | Registered Nurse | 1064 Independence Ave, Akron, OH 44310 | 2008-03-04 |
| 1861672347 | Mary Patricia Moore | Psychiatry & Neurology | 280 Broad St Ste E, Kernersville, NC 27284-2948 | 2007-11-13 |
| 1134314263 | Mary Margaret Moore | Dermatology | 7435 Highway 6 Ste B, Missouri City, TX 77459-4698 | 2007-09-11 |
| 1871799957 | Mary E Moore | Psychologist | 325 W Hospitality Lane, Suite 310, San Bernandino, CA 92408-3212 | 2007-06-25 |
| 1578629309 | Mary A Moore | Social Worker | 19206 Huebner, Ste 104, San Antonio, TX 78258-9800 | 2006-12-28 |
| Street Address |
2905 BREEZEWOOD AVE SUITE 101 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417383704 | Community Alternative Housing, Inc. | Community/Behavioral Health | 2905 Breezewood Ave, Suite 104, Fayetteville, NC 28303-5503 | 2013-09-19 |
| 1447685508 | Wilbert Nichols IIi | Counselor | 2905 Breezewood Ave, Suite 104, Fayetteville, NC 28303-5503 | 2013-09-09 |
| 1629358098 | Charmetri Averious Wrice-bulluck | Social Worker | 2905 Breezewood Ave, Suite 104, Fayetteville, NC 28303-5503 | 2011-08-17 |
| 1033411731 | Armstead Psychiatric Services, Pllc | Psychiatry & Neurology | 2905 Breezewood Ave, Suite 103, Fayetteville, NC 28303-5503 | 2010-12-01 |
| 1720272826 | Community Alternative Housing Inc | Community/Behavioral Health | 2905 Breezewood Ave, Suite 104, Fayetteville, NC 28303-5503 | 2007-08-31 |
| 1942341177 | Youth Development Corporation of America | Community/Behavioral Health | 2905 Breezewood Ave, Suite 101, Fayetteville, NC 28303-5503 | 2007-02-09 |
| 1285783258 | Richard Samuel Daum Sr. | Counselor | 2905 Breezewood Ave, Suite 104, Fayetteville, NC 28303 | 2007-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404496 | Matthew Pace | Physician Assistant | Bldg 5-4257 Bastogne St, Fort Bragg, NC 28303 | 2020-07-20 |
| 1952920449 | Vonetta Bethea Jackson | Social Worker | 391 Wagoner Drive, Fayetteville, NC 28303 | 2020-04-14 |
| 1932746229 | Julie Harriss | Specialist/Technologist | Bldg E 4062, Canopy Lane, Fort Bragg, NC 28303 | 2019-12-05 |
| 1235780354 | Helen Delores Johnson | Technician | 261 Pierron Dr, Fayetteville, NC 28303 | 2019-09-20 |
| 1922655075 | Andrea Margaret Hutnam | Technician | 714 Shortridge Rd, Fayetteville, NC 28303 | 2019-08-23 |
| 1225695273 | Breona Lister | Dental Hygienist | 38 17 Gruber Rd, Fort Bragg, NC 28303 | 2019-05-24 |
| 1780148957 | Brian K Cox Sr. | Occupational Therapy Assistant | 5300 Ramsey St, Fayetteville, NC 28303 | 2019-01-22 |
| 1730670902 | Michael Sadtler | Counselor | 804 Stamper Rd Ste 101, Fayetteville, NC 28303 | 2018-05-23 |
| 1104320399 | Tia Porterfield | Counselor | 2018 Fort Bragg Rd Ste 112a, Fayetteville, NC 28303 | 2018-03-21 |
| 1154835577 | Jessica Bass Bosworth | Psychologist | 3415 Youngstown Dr, Fayetteville, NC 28303 | 2017-11-21 |
| Find all providers in zip 28303 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841899986 | Cynthia Hrdlichka | Counselor | 2224 E Elaine Ave, Fayetteville, AR 72703-4507 | 2020-10-20 |
| 1568069169 | Blaire Bradbury | Counselor | 1466 N Desoto Pl, Fayetteville, AR 72703-1953 | 2020-10-06 |
| 1588294631 | Puzzle Collaborative | Counselor | 34 W Colt Square Dr Ste 1, Fayetteville, AR 72703-2888 | 2020-01-16 |
| 1700421724 | Waylon Vande Hoef | Counselor | 1925 N Green Acres Rd, Fayetteville, AR 72703-2617 | 2019-11-13 |
| 1730640137 | Sherrita Hedgepeth | Counselor | 1351 Glen Iris Dr Apt 105, Fayetteville, NC 28314-6190 | 2019-03-28 |
| 1689139362 | Resiliency Behavioral Health Services LLC | Counselor | 145 Govenors Square, Ste A, Fayetteville, GA 30269 | 2019-02-06 |
| 1073006540 | Rona Gooden | Counselor | 706 Dandridge Dr, Fayetteville, NC 28303-2017 | 2018-06-10 |
| 1194229245 | The Welling Place LLC | Counselor | 2525 Raeford Rd Ste C, Fayetteville, NC 28305-5092 | 2018-03-22 |
| 1104320399 | Tia Porterfield | Counselor | 2018 Fort Bragg Rd Ste 112a, Fayetteville, NC 28303 | 2018-03-21 |
| 1376062539 | Monique R Darnell | Counselor | 320 W. Lanier Avenue Ste 200, Fayetteville, GA 30214 | 2017-09-19 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28303 |
Please comment or provide details below to improve the information on MARY LISA MOORE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.