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General NPI Number Information
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NPI Number | 1659730166
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Entity Type | Individual
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Provider Name | KRISTIN MOORE MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 2140 UPPER WETUMPKA RD
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City | MONTGOMERY
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State | AL
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Zip | 36107-1342
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Country | US
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Telephone | 334-279-7830
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Fax |
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Provider Business Mailing Address
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Address Line | 67 BROOKFIELD DR
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City | ELMORE
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State | AL
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Zip | 36025-1243
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Country | US
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Telephone | 334-462-8817
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3717C
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License Number State | AL
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