Healthcare Provider Details

I. General information

NPI: 1700710423
Provider Name (Legal Business Name): DOROTHY MOORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CIDER ST
PIKE ROAD AL
36064-3057
US

IV. Provider business mailing address

1713 WENTWORTH DR
MONTGOMERY AL
36106-2638
US

V. Phone/Fax

Practice location:
  • Phone: 334-318-8362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05979
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: