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General NPI Number Information
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NPI Number | 1467714089
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Entity Type | Individual
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Provider Name | KELLY CHAPIN MOORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/10/2012
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Last Update Date | 06/10/2012
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Provider Practice Location Address
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Address Line | 10515 W MARKHAM ST STE. I-6
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2297
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Country | US
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Telephone | 501-458-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 10515 W MARKHAM ST STE. I-6
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2297
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Country | US
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Telephone | 501-458-4333
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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 | 2566-C
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License Number State | AR
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