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General NPI Number Information
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NPI Number | 1659663086
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Entity Type | Individual
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Provider Name | BEVERLY SMITH MOORE PHD, LPC, CCMHC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 11/30/2025
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Provider Practice Location Address
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Address Line | 401 WESTPARK CT STE 200
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3572
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Country | US
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Telephone | 678-523-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 3135 DUKE DR
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City | FAIRBURN
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State | GA
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Zip | 30213-8302
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Country | US
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Telephone | 678-523-1715
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | LPC003014
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LPC003014
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC003014
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | LPC003014
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC003014
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LPC003014
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC003014
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | LPC003014
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License Number State | GA
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