Provider Demographics
NPI:1497299804
Name:MOORE CONSULTING COUNSELING GROUP
Entity Type:Organization
Organization Name:MOORE CONSULTING COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:404-272-1293
Mailing Address - Street 1:484 HALWICK WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4377
Mailing Address - Country:US
Mailing Address - Phone:404-272-1293
Mailing Address - Fax:
Practice Address - Street 1:2001 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:SUITE 409
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1101
Practice Address - Country:US
Practice Address - Phone:404-272-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty