Provider Demographics
NPI:1942269394
Name:MOORE, CHRISTARDRA (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTARDRA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTARDRA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2513 FERRAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3210
Mailing Address - Country:US
Mailing Address - Phone:318-362-3270
Mailing Address - Fax:318-362-5051
Practice Address - Street 1:4800 S GRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6412
Practice Address - Country:US
Practice Address - Phone:318-362-3339
Practice Address - Fax:318-362-3336
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0305049101YM0800X
ARP0704014101YP2500X
LA4636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3758342Medicaid