Provider Demographics
NPI:1013010057
Name:MOORE, JAMES C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 BIRKENHEAD CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4204
Mailing Address - Country:US
Mailing Address - Phone:859-281-3949
Mailing Address - Fax:859-281-3952
Practice Address - Street 1:1101 VETERANS DR
Practice Address - Street 2:29-1-LD
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2235
Practice Address - Country:US
Practice Address - Phone:859-281-3949
Practice Address - Fax:859-281-3952
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical