Provider Demographics
NPI:1184771800
Name:MOORE, GAIL (MFT)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-4125
Mailing Address - Country:US
Mailing Address - Phone:770-918-6677
Mailing Address - Fax:770-918-6686
Practice Address - Street 1:977A TAYLOR ST SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5357
Practice Address - Country:US
Practice Address - Phone:770-918-6677
Practice Address - Fax:770-918-6686
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist