Provider Demographics
NPI:1235600396
Name:MOORE, NALICE (RBT)
Entity Type:Individual
Prefix:
First Name:NALICE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 54TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4494
Mailing Address - Country:US
Mailing Address - Phone:706-221-1208
Mailing Address - Fax:904-538-0714
Practice Address - Street 1:1450 54TH ST STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4494
Practice Address - Country:US
Practice Address - Phone:706-221-1208
Practice Address - Fax:904-538-0714
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-131993103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst