Provider Demographics
NPI:1003431594
Name:MOORE, LAVONYA ANN (LPCMH)
Entity Type:Individual
Prefix:
First Name:LAVONYA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CONTINENTAL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4337
Mailing Address - Country:US
Mailing Address - Phone:302-205-6848
Mailing Address - Fax:302-417-0418
Practice Address - Street 1:1 CHESTNUT HILL PLZ # 1197
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2761
Practice Address - Country:US
Practice Address - Phone:302-205-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012774101YP2500X
DEPC-0001009101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional