Healthcare Provider Details

I. General information

NPI: 1831678069
Provider Name (Legal Business Name): LAQUISHA DENISE MOORE M.ED, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W BROADWAY STE 16
LOUISVILLE KY
40211-1294
US

IV. Provider business mailing address

2900 W BROADWAY STE 16
LOUISVILLE KY
40211-1294
US

V. Phone/Fax

Practice location:
  • Phone: 502-315-9969
  • Fax:
Mailing address:
  • Phone: 502-315-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number266373
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number266373
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: