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General NPI Number Information
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NPI Number | 1225511587
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Entity Type | Individual
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Provider Name | DAJAVON JARRIE MOORE-ADU LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 11080 OLD ROSWELL RD
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City | ALPHARETTA
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State | GA
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Zip | 30009-4757
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Country | US
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Telephone | 678-369-3736
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 98405
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City | ATLANTA
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State | GA
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Zip | 30359-2105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW009136
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW007695
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License Number State | GA
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