Healthcare Provider Details

I. General information

NPI: 1255765517
Provider Name (Legal Business Name): ARIEL CHRISTINA MOORE LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ARIEL CHRISTINA FERGUSON-KIRKMAN LPC-S

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 HIGHLAND AVE
SHREVEPORT LA
71101-4143
US

IV. Provider business mailing address

1002 HIGHLAND AVE
SHREVEPORT LA
71101-4143
US

V. Phone/Fax

Practice location:
  • Phone: 318-222-6226
  • Fax: 318-524-7252
Mailing address:
  • Phone: 318-222-6226
  • Fax: 318-524-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5076
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: