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General NPI Number Information
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NPI Number | 1497299804
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Entity Type | Organization
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Legal Business Name | MOORE CONSULTING COUNSELING GROUP
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 2001 MARTIN LUTHER KING JR DR SW SUITE 409
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City | ATLANTA
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State | GA
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Zip | 30310-1101
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Country | US
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Telephone | 404-272-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 484 HALWICK WAY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-4377
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Country | US
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Telephone | 404-272-1293
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | RAQUEL MOORE
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Credential | MSW, LCSW
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Telephone | 404-272-1293
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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 | CSW002692
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License Number State | GA
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