Provider Demographics
NPI:1417488677
Name:MOORE, ANGELA HOPE
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:HOPE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:HOPE
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MCAP
Mailing Address - Street 1:15681 N US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:CITRA
Mailing Address - State:FL
Mailing Address - Zip Code:32113-3154
Mailing Address - Country:US
Mailing Address - Phone:352-595-5000
Mailing Address - Fax:
Practice Address - Street 1:15681 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:CITRA
Practice Address - State:FL
Practice Address - Zip Code:32113-3154
Practice Address - Country:US
Practice Address - Phone:352-595-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility