Provider Demographics
NPI:1174862163
Name:MOORE, CARLA SUTTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:SUTTON
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 1:2015 HYDRANGEA LN
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2680
Mailing Address - Country:US
Mailing Address - Phone:404-791-9257
Mailing Address - Fax:
Practice Address - Street 1:2015 HYDRANGEA LN
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2680
Practice Address - Country:US
Practice Address - Phone:404-791-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist