Keisha McCleese Moore, LPC
Individual provider Active NPI Professional Counselor · Sophia, NC
NPI 1336543776 · NPPES record last updated Jul 18, 2019
Key facts
- NPI
- 1336543776
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- A10870 (NC)
- Practice address
- 2962 Youth Unlimited Dr
Sophia, NC 27350-8481 - Phone
- (336) 861-9243
- NPI assigned
- Oct 14, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A10870 | NC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Youth Unlimited Inc | Professional | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | A10870 | NC | Yes |
Addresses
Primary practice location
2962 Youth Unlimited Dr
Sophia, NC 27350-8481
Mailing address
1052 Glenmont Rd
Winston Salem, NC 27107-1561
Phone (336) 978-4911
Other practice location 1
200 W Parkway Ave
High Point, NC 27262-3026
Phone (336) 289-9789
Other providers in Sophia, NC
- Judith Jan Fradenburg
- Erica Blackwelder Harwell
- Jane Elizabeth Hoonhout
- Clodagh Leszinski
- Robert Andrew Lindsay Jr.
- Frank David Mullins
- Melanie Coble Paschal
- Martha R Powell
- Debra Lanier Tatum
- Youth Unlimited Inc
All providers in Sophia, NC · Professional Counselor in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.