Provider Demographics
NPI:1245064518
Name:MOORE, BRITTNEY LATOYA (MSW BSW CSW, MHP)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:LATOYA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSW BSW CSW, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CHINABERRY DR STE 900
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2455
Mailing Address - Country:US
Mailing Address - Phone:318-459-6795
Mailing Address - Fax:
Practice Address - Street 1:525 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2001
Practice Address - Country:US
Practice Address - Phone:318-259-4676
Practice Address - Fax:318-259-4676
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16688104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker