MEDICARE: SHIRLEY LUONG MOORE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0701012555	VA

General Provider Information

NPI Number	:	1356021950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY LUONG MOORE LPC

Provider Business Mailing Address
First Line	:	4114 HILLCREST RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3312
Country	:	US
Telephone Number	:	804-332-7865
Fax Number	:

Provider Business Practice Location Address
First Line	:	9211 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6874
Country	:	US
Telephone Number	:	757-296-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	07/19/2023

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