Provider Demographics
NPI:1407634413
Name:MOORE, LAQUITA VANDIANA
Entity Type:Individual
Prefix:MRS
First Name:LAQUITA
Middle Name:VANDIANA
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF SOCIAL WORK -BHWTP2
Mailing Address - Street 2:GRADUATE SOCIAL WORK BUCHANAN HALL SUITE 124
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762
Mailing Address - Country:US
Mailing Address - Phone:205-218-4474
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF SOCIAL WORK -BHWTP2
Practice Address - Street 2:GRADUATE SOCIAL WORK BUCHANAN HALL SUITE 124
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762
Practice Address - Country:US
Practice Address - Phone:205-218-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker