Provider Demographics
NPI:1245065234
Name:MOORE, KIERSTEN (LPC, # 0701013957)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, # 0701013957
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 YORK CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-2947
Mailing Address - Country:US
Mailing Address - Phone:757-712-4099
Mailing Address - Fax:
Practice Address - Street 1:5131 RIVER CLUB DR STE 200
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3837
Practice Address - Country:US
Practice Address - Phone:855-581-3711
Practice Address - Fax:804-730-2829
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013957101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health