Healthcare Provider Details

I. General information

NPI: 1326951047
Provider Name (Legal Business Name): ASHLEY NICOLE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 3RD AVE
ALBANY GA
31701-1985
US

IV. Provider business mailing address

2906 OLD FLOWING WELL RD
LEESBURG GA
31763-1105
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-7001
  • Fax:
Mailing address:
  • Phone: 229-343-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC010880
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: