MEDICARE: CAROL L. MOORE M.A.; 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	LPC005351	GA
2	101YP2500X	Professional Counselor	LPC005351	GA

General Provider Information

NPI Number	:	1811147366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L. MOORE M.A.; LPC

Provider Business Mailing Address
First Line	:	1720 MARS HILL RD NW STE 124-308
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-7127
Country	:	US
Telephone Number	:	678-919-1077
Fax Number	:	678-317-3991

Provider Business Practice Location Address
First Line	:	1720 MARS HILL RD NW
Second Line	:	STE. 124-308
City	:	ACWORTH
State	:	GA
Zip	:	30101-7127
Country	:	US
Telephone Number	:	678-919-1077
Fax Number	:	678-317-3991

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

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	09/16/2024

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