Doctor Name: | MS. DANETTE MOORE |
NPI Number: | 1447499603 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LPC |
License Number: | 3309 |
Business Practice Address: | 2520 Line Ave Shreveport, LA - 711043022 |
Business Phone Number: | 3186179493 |
Business Fax Number: | |
Mailing Address: | 2520 Line Ave, SHREVEPORT |
State: | LA |
Postal Code: | 711043022 |
Phone Number: | 3186179493 |
Fax Number: | |
NPI Enumeration Date: | 02/11/2009 |
NPI Last Update Date: | 02/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3309 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |