Provider Demographics
NPI:1487213328
Name:MOORE, PEGGY A (LCPCC)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 UNITY LN
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1021
Mailing Address - Country:US
Mailing Address - Phone:207-865-4479
Mailing Address - Fax:
Practice Address - Street 1:8 UNITY LN
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1021
Practice Address - Country:US
Practice Address - Phone:207-865-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health