Provider Demographics
NPI:1457415853
Name:MOORE, CASSANDRA JO (PHD, MA, LPC, LPC/S)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:JO
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, MA, LPC, LPC/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:SC
Mailing Address - Zip Code:29112-8165
Mailing Address - Country:US
Mailing Address - Phone:803-604-6253
Mailing Address - Fax:
Practice Address - Street 1:3122 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:NORTH
Practice Address - State:SC
Practice Address - Zip Code:29112-8165
Practice Address - Country:US
Practice Address - Phone:803-604-6253
Practice Address - Fax:855-397-9171
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC5056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health