Provider Demographics
NPI:1235148602
Name:MOORE, DEBRA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
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 1:805 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1870
Mailing Address - Country:US
Mailing Address - Phone:404-321-7073
Mailing Address - Fax:404-377-6798
Practice Address - Street 1:805 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1870
Practice Address - Country:US
Practice Address - Phone:404-321-7073
Practice Address - Fax:404-377-6798
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical