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 1:1282 SMALLWOOD DR W # 162
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4732
Mailing Address - Country:US
Mailing Address - Phone:240-232-5554
Mailing Address - Fax:
Practice Address - Street 1:1282 SMALLWOOD DR W # 162
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4732
Practice Address - Country:US
Practice Address - Phone:240-232-5554
Practice Address - Fax:240-607-8464
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health