Provider Demographics
NPI:1164671996
Name:MOORE, RODNEY ERIC (LMHC)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:ERIC
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8602
Mailing Address - Country:US
Mailing Address - Phone:850-292-2922
Mailing Address - Fax:
Practice Address - Street 1:3500 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32571-8602
Practice Address - Country:US
Practice Address - Phone:850-292-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-4896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767242000Medicaid