Provider Demographics
NPI:1629306279
Name:MOORE, ANGELA FAULKNER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:FAULKNER
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:#789
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8408
Mailing Address - Fax:501-296-1477
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:#789
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8408
Practice Address - Fax:501-296-1477
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2176-M104100000X
AR2611-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker