Most Relevant Information
Provider Data
| NPI Number: | 1003254293 |
| Provider Name: | JESSICA THERESA MOORE-TYSON LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 7967 |
Most Important Dates
| Enumeration Date: | 06/10/2013 |
| Last Updated: | 06/10/2013 |
Provider Practice Location
105 SIERRA PL
JACKSONVILLE
NC
285467364
Practice Location Phone/Fax
| Phone: | 9105548387 |
| Fax: |
Provider Mailing Location
105 SIERRA PL
JACKSONVILLE
NC
285467364
Provider Mailing Phone/Fax
| Phone: | 9105548387 |
| Fax: |