Provider Demographics
NPI:1447766613
Name:MOORMAN, WILLLIAM JOSEPH (MDIV, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLLIAM
Middle Name:JOSEPH
Last Name:MOORMAN
Suffix:
Gender:M
Credentials:MDIV, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2942
Mailing Address - Country:US
Mailing Address - Phone:410-227-0225
Mailing Address - Fax:
Practice Address - Street 1:611 PARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4572
Practice Address - Country:US
Practice Address - Phone:410-777-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-23
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1263101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral