Provider Demographics
NPI:1649925264
Name:MOORE, ANNABELLE CORINNE (LPC)
Entity type:Individual
Prefix:MS
First Name:ANNABELLE
Middle Name:CORINNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CROSS COUNTRY DRIVE
Mailing Address - Street 2:CONDOMINIUM B-2, SUITE 900
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3814
Mailing Address - Country:US
Mailing Address - Phone:706-596-7170
Mailing Address - Fax:
Practice Address - Street 1:2601 CROSS COUNTRY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-1801
Practice Address - Country:US
Practice Address - Phone:706-596-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012713101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor