Provider Demographics
NPI:1265533368
Name:MOORE, ANGELA ELLEN (LCMHCS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ELLEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:ELLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCS
Mailing Address - Street 1:1101 W 40TH ST UNIT 2225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-1379
Mailing Address - Country:US
Mailing Address - Phone:877-358-2998
Mailing Address - Fax:423-405-6346
Practice Address - Street 1:6781 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-7223
Practice Address - Country:US
Practice Address - Phone:877-358-2998
Practice Address - Fax:423-405-6346
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS5187101YP2500X, 101Y00000X, 104100000X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist