Provider Demographics
NPI:1265646632
Name:MOORE, NICOLE R (MSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2507
Mailing Address - Country:US
Mailing Address - Phone:302-792-0700
Mailing Address - Fax:302-798-2608
Practice Address - Street 1:2999 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2507
Practice Address - Country:US
Practice Address - Phone:302-792-0700
Practice Address - Fax:302-798-2608
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)