Provider Demographics
NPI:1659836187
Name:MOORE, VALERIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:24393 ROCK POND CT
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3305
Mailing Address - Country:US
Mailing Address - Phone:210-683-9130
Mailing Address - Fax:
Practice Address - Street 1:24393 ROCK POND CT
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3305
Practice Address - Country:US
Practice Address - Phone:210-683-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06804500104100000X
TX518551041C0700X
VA09040150491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07831800OtherTEXAS DRIVERS LIENSE NUMBER