Provider Demographics
NPI:1073986451
Name:MOORE, MARIEL DEES
Entity Type:Individual
Prefix:MRS
First Name:MARIEL
Middle Name:DEES
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E SOUTH BLVD
Mailing Address - Street 2:SUITE #135
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2515
Mailing Address - Country:US
Mailing Address - Phone:334-202-5495
Mailing Address - Fax:
Practice Address - Street 1:2600 E SOUTH BLVD
Practice Address - Street 2:SUITE #135
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2515
Practice Address - Country:US
Practice Address - Phone:334-202-5495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor