Provider Demographics
NPI:1275848020
Name:MOORE, JULIE (LISW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W GREENWOOD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5717
Mailing Address - Country:US
Mailing Address - Phone:864-366-9938
Mailing Address - Fax:864-366-5600
Practice Address - Street 1:901 W GREENWOOD ST STE 1
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5727
Practice Address - Country:US
Practice Address - Phone:864-366-9938
Practice Address - Fax:864-366-5600
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6858OtherLICENSE
SCRHC549Medicaid
SCSW1099Medicaid
SC9337Medicare PIN