Provider Demographics
NPI:1518515527
Name:MOORE, DANA (LPC NCC BC-TMH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC NCC BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-3700
Mailing Address - Country:US
Mailing Address - Phone:601-476-4700
Mailing Address - Fax:
Practice Address - Street 1:128 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-3700
Practice Address - Country:US
Practice Address - Phone:601-476-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health