Provider Demographics
NPI:1043613664
Name:MOORE, LYDIA MICHELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4785
Mailing Address - Country:US
Mailing Address - Phone:256-741-8265
Mailing Address - Fax:256-741-8266
Practice Address - Street 1:721 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4785
Practice Address - Country:US
Practice Address - Phone:256-741-8265
Practice Address - Fax:256-741-8266
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3325101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor