MEDICARE: MS. ASHLEY BRIANNA 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	101YP2500X	Professional Counselor	LPC014860	GA

General Provider Information

NPI Number	:	1487433041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY BRIANNA MOORE LPC

Provider Business Mailing Address
First Line	:	6000 LYNMARK WAY STE 106
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-4844
Country	:	US
Telephone Number	:	470-484-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 LYNMARK WAY STE 106
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-4844
Country	:	US
Telephone Number	:	470-484-2323
Fax Number	:

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

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	12/15/2025

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