Provider Demographics
NPI:1588813299
Name:MOORE, KIRSTEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CHISWICK CLOSE
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6675
Mailing Address - Country:US
Mailing Address - Phone:678-644-0039
Mailing Address - Fax:678-669-2740
Practice Address - Street 1:4080 MCGINNIS FERRY RD
Practice Address - Street 2:STE. 204
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:678-644-0039
Practice Address - Fax:678-669-2740
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical