Provider Demographics
NPI:1851423347
Name:MOORE, DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N HIGH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1324
Mailing Address - Country:US
Mailing Address - Phone:931-962-0330
Mailing Address - Fax:
Practice Address - Street 1:407 N HIGH ST
Practice Address - Street 2:APT. 1
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1324
Practice Address - Country:US
Practice Address - Phone:931-962-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional