Provider Demographics
NPI:1700213766
Name:MOORE, DOROTHY M (PHD, LPC, ACS)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 TYRE NECK RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3319
Mailing Address - Country:US
Mailing Address - Phone:757-419-1871
Mailing Address - Fax:
Practice Address - Street 1:3300 TYRE NECK RD STE A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3319
Practice Address - Country:US
Practice Address - Phone:757-419-1871
Practice Address - Fax:844-374-3058
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VA0701005610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional