Provider Demographics
NPI:1720766157
Name:MOORE, WESTON ALLEN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WESTON
Middle Name:ALLEN
Last Name:MOORE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 FAIRWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8069
Mailing Address - Country:US
Mailing Address - Phone:501-771-8261
Mailing Address - Fax:
Practice Address - Street 1:4701 FAIRWAY AVE STE B
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8069
Practice Address - Country:US
Practice Address - Phone:501-771-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12903-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker