Provider Demographics
NPI:1720447162
Name:MOORE, DIANE D (MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CHESTNUT RD STE 9
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1535
Mailing Address - Country:US
Mailing Address - Phone:610-644-8182
Mailing Address - Fax:610-644-9010
Practice Address - Street 1:63 CHESTNUT RD
Practice Address - Street 2:SUITE 9
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1535
Practice Address - Country:US
Practice Address - Phone:610-644-8182
Practice Address - Fax:610-644-9010
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health