Zellua Sistrunk Moore, MSW, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P017958 Issued in NC

Practice address

303 Trillium St NW
Concord, NC 28027-7206

Phone

(980) 271-4628

NPI assigned

Sep 30, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1664496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1649994906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6012 BAYFIELD PKWY # 386",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280277597",
            "telephone_number": "980-271-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 TRILLIUM ST NW",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280277206",
            "telephone_number": "980-271-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISTRUNK MOORE",
        "first_name": "ZELLUA",
        "credential": "MSW, LCSWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-30",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P017958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "92-0482059",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ZELLUA@HEALINGCOLORFULLY.COM",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6012 Bayfield Pkwy # 386",
            "city": "Concord",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280277597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Suzanna Singh, PHARM.D.
• Travasia Eterniti Dubose Singletary-Scott
• Samuel Sirakanyan, PSY.D.
• Krista Sirois, MD
• Providence Sisomphou
• Rebecca Jyll Siwanowicz, LCSW
• Gracie Ann Sizemore
• Laura Skaff, PHARMD
• James Raymond Skahen III, MD
• Cora Skillman-Woods

• Clinical Social Worker in Concord, NC
• Providers in Concord, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; 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.