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General NPI Number Information
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NPI Number | 1467897728
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Entity Type | Individual
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Provider Name | EBONY STAR BAKER-MOORE EDD,LPC,MFT
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Gender | Female
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 316 ALEXANDER STREET SUITE 2
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-7205
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Country | US
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Telephone | 404-597-9910
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Fax | 888-908-7984
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Provider Business Mailing Address
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Address Line | 3486 MCKOWN RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2812
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Country | US
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Telephone | 404-597-9910
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Fax | 888-908-7984
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007289
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC007289
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License Number State | GA
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