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General NPI Number Information
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NPI Number | 1588854533
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Entity Type | Individual
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Provider Name | CHEWANDA RENEE MOORE LPC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 793 GABRIEL LN
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-1118
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Country | US
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Telephone | 757-286-8071
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Fax |
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Provider Business Mailing Address
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Address Line | 793 GABRIEL LANE
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City | NEWPORT NEWS
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State | VA
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Zip | 23608
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Country | US
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Telephone | 757-286-8071
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710102156
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004210
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License Number State | VA
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