Moore, Kenetra Devonne

Moore, Kenetra Devonne is an individual health care provider with primary practice located at 1900 Randolph Rd Ste 800 , Charlotte NC 28207-1110. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Moore, Kenetra Devonne can be contacted via phone (704) 384-1246.

Contact Information

Primary practice address
1900 Randolph Rd Ste 800 Charlotte NC 28207-1110
Phone: (704) 384-1246
Fax: (704) 384-6072
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 15759 North Carolina
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 20215 North Carolina

Profile Details

NPI number 1407263593
LBN Legal business name Moore, Kenetra Devonne
Credentials LCMHC, LCAS, CCS
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2014
Last updated May 1st, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407263593 NPPES
North Carolina MEDICAID 21286

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