Provider Demographics
NPI:1679817142
Name:MOORE, MARILEA DEBAER (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARILEA
Middle Name:DEBAER
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 OLEANDER DR STE 204
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3582
Mailing Address - Country:US
Mailing Address - Phone:910-233-6612
Mailing Address - Fax:
Practice Address - Street 1:6209 OLEANDER DR STE 204
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3582
Practice Address - Country:US
Practice Address - Phone:910-212-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0090771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical