Healthcare Provider Details

I. General information

NPI: 1467697524
Provider Name (Legal Business Name): MONIQUE R DELAY-MOORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONIQUE R MOORE LCSW

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4116 ARKWRIGHT RD STE 1
MACON GA
31210-1707
US

IV. Provider business mailing address

PO BOX 6619
MACON GA
31208-6619
US

V. Phone/Fax

Practice location:
  • Phone: 478-216-5534
  • Fax: 478-333-2173
Mailing address:
  • Phone: 317-809-0512
  • Fax: 478-333-2173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004960
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number004960
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: