Healthcare Provider Details

I. General information

NPI: 1437374535
Provider Name (Legal Business Name): ANGELA K MOORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4186 MILL ST NE
COVINGTON GA
30014-2540
US

IV. Provider business mailing address

4186 MILL ST NE
COVINGTON GA
30014-2540
US

V. Phone/Fax

Practice location:
  • Phone: 770-787-2301
  • Fax: 770-787-9460
Mailing address:
  • Phone: 770-787-2301
  • Fax: 770-787-9460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC001501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: