Provider Demographics
NPI:1629428735
Name:MOORE, WINNIE D (LCPC)
Entity type:Individual
Prefix:
First Name:WINNIE
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3510
Mailing Address - Country:US
Mailing Address - Phone:240-346-9712
Mailing Address - Fax:
Practice Address - Street 1:2670 CRAIN HWY STE 105
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2820
Practice Address - Country:US
Practice Address - Phone:240-232-5554
Practice Address - Fax:240-366-7076
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health