Provider Demographics
NPI:1356479323
Name:MOORE, JANICE DENICE (MA)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:DENICE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:DENICE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 S PLEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4612
Mailing Address - Country:US
Mailing Address - Phone:615-384-1175
Mailing Address - Fax:
Practice Address - Street 1:230 VENTURE CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1604
Practice Address - Country:US
Practice Address - Phone:615-460-4224
Practice Address - Fax:615-460-4202
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional