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General NPI Number Information
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NPI Number | 1992994479
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Entity Type | Individual
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Provider Name | HOLLY D MOORE LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 212 CHEROKEE RD
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City | THOMASTON
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State | GA
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Zip | 30286-3402
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Country | US
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Telephone | 706-646-4702
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Fax | 770-229-8893
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Provider Business Mailing Address
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Address Line | 212 CHEROKEE RD
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City | THOMASTON
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State | GA
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Zip | 30286-3402
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Country | US
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Telephone | 706-646-4702
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Fax | 770-229-8893
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 000955
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License Number State | GA
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