Provider Demographics
NPI:1184299471
Name:MOORE, CHRISTINE LI'CHELE' (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LI'CHELE'
Last Name:MOORE
Suffix:
Gender:F
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:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33583-1526
Mailing Address - Country:US
Mailing Address - Phone:813-531-5380
Mailing Address - Fax:
Practice Address - Street 1:1315 W SPRUCE ST STE 113
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3510
Practice Address - Country:US
Practice Address - Phone:727-277-9317
Practice Address - Fax:813-531-5380
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH111296101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101Y00000XBehavioral Health & Social Service ProvidersCounselor