Provider Demographics
NPI:1063678993
Name:MOORE, DEBORAH S (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 INDIAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6429
Mailing Address - Country:US
Mailing Address - Phone:334-744-7835
Mailing Address - Fax:
Practice Address - Street 1:510 MIMOSA AVE
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-2127
Practice Address - Country:US
Practice Address - Phone:334-318-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPSY703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical