Provider Demographics
NPI:1316376577
Name:MOORE, CHRISTINE M (LPC, SW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, SW
Other - Prefix:MRS
Other - First Name:CHRIS
Other - Middle Name:M
Other - Last Name:MOORE-BARBOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, SW
Mailing Address - Street 1:2001 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3707
Mailing Address - Country:US
Mailing Address - Phone:608-807-8632
Mailing Address - Fax:
Practice Address - Street 1:2001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-3707
Practice Address - Country:US
Practice Address - Phone:608-807-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6962-125101YP2500X
WI39-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker