Provider Demographics
NPI:1053648550
Name:MCMOORE, JANICE MARQUETTE (CSAC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARQUETTE
Last Name:MCMOORE
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BEECHAM DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1302
Mailing Address - Country:US
Mailing Address - Phone:804-918-0069
Mailing Address - Fax:804-918-1755
Practice Address - Street 1:401 BEECHAM DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1302
Practice Address - Country:US
Practice Address - Phone:804-918-0069
Practice Address - Fax:804-918-1755
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101439101YA0400X
VA0701006071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)