Active NPI
Brenda Moore
- Professional Counselor
- Durham, NC
National Provider Identifier
1356370605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5328
- Practice address
- 1906 Hwy. 54
Suite 200
Durham, NC 27713 - Phone
- (919) 405-2177
- Fax
- (919) 544-4611
- NPI assigned
- Jun 30, 2006
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5328 | NC | Primary |
Addresses
Primary practice location
1906 Hwy. 54
Suite 200
Durham, NC 27713
Mailing address
2205 Eider CT
Graham, NC 27253-8800
Phone (919) 405-2177
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5328 | NC | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mental Health Specialty Group PA | Professional | Current | Accepting new patients |
| Grow Healthcare Group PA | Professional | Current | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
3511 Shannon Rd
Fl 3
Durham, NC 27707
Phone (201) 293-7689
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356370605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2205 EIDER CT",
"city": "GRAHAM",
"state": "NC",
"postal_code": "272538800",
"telephone_number": "919-405-2177",
"fax_number": "919-544-4611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1906 HWY. 54",
"address_2": "SUITE 200",
"city": "DURHAM",
"state": "NC",
"postal_code": "27713",
"telephone_number": "919-405-2177",
"fax_number": "919-544-4611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "BRENDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "5328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.