Kathleen J. Walsh Moore, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11771 Issued in NC

Practice address

2000 Regency Pkwy Ste 255
Cary, NC 27518-8511

Phone

(704) 360-3637

Fax

(980) 939-8769

NPI assigned

Jul 14, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crossroads Services Board

  • Community/Behavioral Health Agency
  • Farmville, VA
  • NPI 1528091063

  Mental Health

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1184853939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 DOUGLAS CHURCH ROAD",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "23901",
            "telephone_number": "804-244-1125",
            "fax_number": "434-392-9221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 REGENCY PKWY STE 255",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275188511",
            "telephone_number": "704-360-3637",
            "fax_number": "980-939-8769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "216 Bush River Drive",
            "address_purpose": "LOCATION",
            "city": "Farmville",
            "state": "VA",
            "postal_code": "23901",
            "country_code": "US",
            "telephone_number": "434-392-7049",
            "fax_number": "434-392-9221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KATHLEEN",
        "middle_name": "J. WALSH",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-14",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "VA",
            "license": "0710101961",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0701003192",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "11771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528091063",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gracie Moore
• Jade Elizabeth Moore
• Jason W Moore
• Jasonne Yvette Moore
• Jennifer Marie Moore, PA
• Kristen M Moore, PHARM.D
• Lashay Moore, BEHAVIOR TECHNICIAN
• Marshel Moore, N.P.
• McKenna Marie Moore
• Michelle Marie Moore, RBT

• Mental Health Counselor in Cary, NC
• Providers in Cary, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.