Provider Demographics
NPI:1073914115
Name:MONIQUE RECHELLE DELAY MOORE
Entity Type:Organization
Organization Name:MONIQUE RECHELLE DELAY MOORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:RECHELLE
Authorized Official - Last Name:DELAY-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-809-0512
Mailing Address - Street 1:646 MILLRUN COURT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:317-809-0512
Mailing Address - Fax:
Practice Address - Street 1:646 MILLRUN COURT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:317-809-0512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004960251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health