Provider Demographics
NPI:1184429722
Name:MOORE, ALEXANDRA RENEE (LPC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RENEE
Last Name:MOORE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-5604
Mailing Address - Country:US
Mailing Address - Phone:717-991-8404
Mailing Address - Fax:
Practice Address - Street 1:412 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1117
Practice Address - Country:US
Practice Address - Phone:717-386-5971
Practice Address - Fax:717-386-5635
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health