Provider Demographics
NPI:1467697524
Name:DELAY-MOORE, MONIQUE R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:R
Last Name:DELAY-MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:R
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 6619
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6619
Mailing Address - Country:US
Mailing Address - Phone:317-809-0512
Mailing Address - Fax:478-333-2173
Practice Address - Street 1:4116 ARKWRIGHT RD STE 1
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1707
Practice Address - Country:US
Practice Address - Phone:478-216-5534
Practice Address - Fax:478-333-2173
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004960251S00000X
GACSW0049601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003163200AMedicaid
GA2021806774Medicare Oscar/Certification