Provider Demographics
NPI:1609071109
Name:MOORE, ANGELA JANNETTE (LPC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JANNETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:ROSS
Other - Last Name:GALLIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5484 LITTLETON KILGORE RD
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-2547
Mailing Address - Country:US
Mailing Address - Phone:205-365-7699
Mailing Address - Fax:205-648-4551
Practice Address - Street 1:2165 HIGHWAY 78
Practice Address - Street 2:SUITE 100
Practice Address - City:DORA
Practice Address - State:AL
Practice Address - Zip Code:35062-4548
Practice Address - Country:US
Practice Address - Phone:205-648-4567
Practice Address - Fax:205-648-4551
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2425101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
515-41132OtherBLUE CROSS BLUE SHIELD