Provider Demographics
NPI:1750500856
Name:MOORE, ANTONIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANTONIA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 HAVERLING DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9159
Mailing Address - Country:US
Mailing Address - Phone:713-349-9796
Mailing Address - Fax:713-436-6859
Practice Address - Street 1:2616 S LOOP W
Practice Address - Street 2:STE 602
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2662
Practice Address - Country:US
Practice Address - Phone:713-349-9796
Practice Address - Fax:713-349-9796
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical