KENETRA DEVONNE MOORE LCMHC LCAS CCS NPI 1407263593

NPI Information

NPI: 1407263593
Provider Name: KENETRA DEVONNE MOORE, LCMHC, LCAS, CCS
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
3301 TENNESSEE AVE
CHARLOTTE, NC
ZIP 28216
Phone: (704) 900-1850
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Kenetra Devonne Moore, LCMHC, LCAS, CCS is an addiction (substance use disorder) counselor in Charlotte, NC. Kenetra Devonne Moore, LCMHC, LCAS, CCS NPI is 1407263593. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3301 TENNESSEE AVE
CHARLOTTE, NC
ZIP 28216-077
Phone: (704) 900-1850

The enumeration date for this NPI number is 7/21/2014 and was last updated on 4/25/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	20215	NORTH CAROLINA	No
2	101YM0800X	Counselor	Mental Health	15759	NORTH CAROLINA	No
3	101YA0400X	Counselor	Addiction (Substance Use Disorder)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	21286	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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