Provider Demographics
NPI:1568864221
Name:MOORE, LINDA (LCDC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 THOMPSON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4960
Mailing Address - Country:US
Mailing Address - Phone:281-762-1082
Mailing Address - Fax:281-762-2897
Practice Address - Street 1:2006 THOMPSON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4960
Practice Address - Country:US
Practice Address - Phone:281-762-1082
Practice Address - Fax:281-762-2897
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6368101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)