Provider Demographics
NPI:1508627142
Name:MOORE, KAREN LOLETA (LICSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOLETA
Last Name:MOORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2029
Mailing Address - Country:US
Mailing Address - Phone:205-393-9796
Mailing Address - Fax:
Practice Address - Street 1:508 GREENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-2318
Practice Address - Country:US
Practice Address - Phone:334-624-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4532C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical