Provider Demographics
NPI:1013260405
Name:MOORE, CHRISTIANA (MPA, MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIANA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MPA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 N 7TH ST
Mailing Address - Street 2:VALLE DEL SOL
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5005
Mailing Address - Country:US
Mailing Address - Phone:480-331-4539
Mailing Address - Fax:
Practice Address - Street 1:3807 N 7TH ST
Practice Address - Street 2:VALLE DEL SOL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5005
Practice Address - Country:US
Practice Address - Phone:480-331-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-136221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical