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General NPI Number Information
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NPI Number | 1720447162
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Entity Type | Individual
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Provider Name | DIANE D MOORE M.S. LPC
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Gender | Female
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Dates
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Enumeration Date | 02/13/2016
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Last Update Date | 02/13/2016
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Provider Practice Location Address
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Address Line | 63 CHESTNUT RD SUITE 9
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City | PAOLI
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State | PA
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Zip | 19301-1535
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Country | US
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Telephone | 610-644-8182
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Fax | 610-644-9010
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Provider Business Mailing Address
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Address Line | 63 CHESTNUT RD STE 9
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City | PAOLI
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State | PA
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Zip | 19301-1535
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Country | US
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Telephone | 610-644-8182
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Fax | 610-644-9010
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC003385
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License Number State | PA
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