Provider Demographics
NPI:1265747745
Name:MOORE, AARON BERNARD (BSW,MFT, LMSW)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:BERNARD
Last Name:MOORE
Suffix:
Gender:M
Credentials:BSW,MFT, LMSW
Other - Prefix:MR
Other - First Name:AARON
Other - Middle Name:BERNARD
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW MFT LMSW
Mailing Address - Street 1:112 ALGRAVE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8117
Mailing Address - Country:US
Mailing Address - Phone:843-437-3386
Mailing Address - Fax:
Practice Address - Street 1:112 ALGRAVE WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8117
Practice Address - Country:US
Practice Address - Phone:843-437-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC10966171M00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator