Provider Demographics
NPI:1346306479
Name:MOORE, DACIA L (LPC)
Entity Type:Individual
Prefix:MS
First Name:DACIA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8301 STATE LINE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2025
Mailing Address - Country:US
Mailing Address - Phone:816-767-9460
Mailing Address - Fax:816-767-9460
Practice Address - Street 1:8301 STATE LINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2025
Practice Address - Country:US
Practice Address - Phone:816-767-9460
Practice Address - Fax:816-767-9460
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO002758101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor