Provider Demographics
NPI:1093047961
Name:MOORE, LINDSEY CLARKE (LICSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:CLARKE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:MS
Other - First Name:LINDSEY
Other - Middle Name:LEE
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1707 BELLE VIEW BLVD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6727
Mailing Address - Country:US
Mailing Address - Phone:571-289-9729
Mailing Address - Fax:
Practice Address - Street 1:1707 BELLE VIEW BLVD
Practice Address - Street 2:SUITE C-2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6727
Practice Address - Country:US
Practice Address - Phone:571-289-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072801041C0700X
DCLC500787031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical