Active NPI
Vicki Lynn Moak, LCPC, NCC
- Mental Health Counselor
- Baltimore, MD
National Provider Identifier
1306608245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LC8580
- Practice address
- 5008 Edmondson Ave
Baltimore, MD 21229-2332 - Phone
- (410) 246-1508
- NPI assigned
- Jan 25, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LC8580 | MD | Primary |
Addresses
Primary practice location
5008 Edmondson Ave
Baltimore, MD 21229-2332
Mailing address
48 Bragg Dr
East Berlin, PA 17316-9342
Phone (301) 318-8596
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC8580 | MD | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706140800000",
"number": "1306608245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 BRAGG DR",
"city": "EAST BERLIN",
"state": "PA",
"postal_code": "173169342",
"telephone_number": "301-318-8596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5008 EDMONDSON AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212292332",
"telephone_number": "410-246-1508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOAK",
"first_name": "VICKI",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "LCPC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-25",
"last_updated": "2024-01-25",
"certification_date": "2024-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LC8580",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.