Provider Demographics
NPI:1659542959
Name:MOORE, JARENE Y
Entity Type:Individual
Prefix:MS
First Name:JARENE
Middle Name:Y
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JARENE
Other - Middle Name:Y
Other - Last Name:MOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 MARKET ST STE C-9
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4321
Mailing Address - Country:US
Mailing Address - Phone:803-713-7604
Mailing Address - Fax:803-713-7605
Practice Address - Street 1:1001 MARKET ST STE C-9
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4321
Practice Address - Country:US
Practice Address - Phone:803-713-7604
Practice Address - Fax:803-713-7605
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5036101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health