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General NPI Number Information
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NPI Number | 1477625580
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Entity Type | Organization
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Legal Business Name | ANTONIA MOORE
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 7505 FANNIN ST STE 310
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City | HOUSTON
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State | TX
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Zip | 77054-1945
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Country | US
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Telephone | 713-349-9796
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Fax | 877-594-6465
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Provider Business Mailing Address
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Address Line | 3014 HAVERLING DR
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City | PEARLAND
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State | TX
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Zip | 77584-9159
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Country | US
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Telephone | 713-349-9796
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Fax | 877-594-6465
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. ANTONIA W. MOORE
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Credential | LCSW
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Telephone | 713-349-9796
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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 | 35520
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License Number State | TX
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