Provider Demographics
NPI:1770773210
Name:MOORE, REBECCA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:625 GEORGIA AVENUE
Mailing Address - Street 2:CENTER FOR CARE AND COUNSELING FOR THE CSRA INC
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841
Mailing Address - Country:US
Mailing Address - Phone:803-819-9021
Mailing Address - Fax:803-819-9028
Practice Address - Street 1:2230 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:803-919-9021
Practice Address - Fax:803-819-9028
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0022711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical