Provider Demographics
NPI:1225167836
Name:MOORE, DOROTHY VIRGINIA (LCSW-C,BCD)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:VIRGINIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW-C,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 KIMBLEWICK DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6320
Mailing Address - Country:US
Mailing Address - Phone:301-680-7916
Mailing Address - Fax:301-680-7916
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2606
Practice Address - Country:US
Practice Address - Phone:301-593-6554
Practice Address - Fax:301-754-1034
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD010271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical