Active NPI
Gloria Dianne Moon, LPA
- Professional Counselor
- Concord, NC
National Provider Identifier
1962449124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2089
- Practice address
- 380 Copperfield Blvd NE
NE Psychiatric & Psychological Inst
Concord, NC 28025-2402 - Phone
- (704) 262-1800
- Fax
- (704) 262-1836
- NPI assigned
- May 31, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 2089 | NC | Primary |
Addresses
Primary practice location
380 Copperfield Blvd NE
NE Psychiatric & Psychological Inst
Concord, NC 28025-2402
Mailing address
380 Copperfield Blvd NE
NE Psychiatric & Psychological Inst
Concord, NC 28025-2402
Phone (704) 262-1800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107201 | Medicaid | NC | |
| 137PE | Other | NC | BCBS PROV ID |
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 |
|---|---|---|---|
| 2089 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1962449124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380 COPPERFIELD BLVD NE",
"address_2": "NE PSYCHIATRIC & PSYCHOLOGICAL INST",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252402",
"telephone_number": "704-262-1800",
"fax_number": "704-262-1836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380 COPPERFIELD BLVD NE",
"address_2": "NE PSYCHIATRIC & PSYCHOLOGICAL INST",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252402",
"telephone_number": "704-262-1800",
"fax_number": "704-262-1836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "GLORIA",
"middle_name": "DIANNE",
"credential": "LPA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-31",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "2089",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107201",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROV ID",
"identifier": "137PE",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.