Provider Demographics
NPI:1659418853
Name:MOORE, LISA RAINEY (MED)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RAINEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
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Mailing Address - Street 1:5750 LAKE RESORT DR
Mailing Address - Street 2:APT. G107
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-7037
Mailing Address - Country:US
Mailing Address - Phone:423-954-8890
Mailing Address - Fax:423-954-8880
Practice Address - Street 1:5726 MARLIN RD.
Practice Address - Street 2:STE. 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411
Practice Address - Country:US
Practice Address - Phone:423-954-8890
Practice Address - Fax:423-954-8880
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health