Healthcare Provider Details

I. General information

NPI: 1831724384
Provider Name (Legal Business Name): MOORE PROFESSIONAL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LEAKE ST STE 106
CARTERSVILLE GA
30120-3562
US

IV. Provider business mailing address

200 LEAKE ST STE 106
CARTERSVILLE GA
30120-3562
US

V. Phone/Fax

Practice location:
  • Phone: 470-433-5048
  • Fax:
Mailing address:
  • Phone: 470-433-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY KING MOORE
Title or Position: LPC
Credential: MS
Phone: 470-433-5048