Provider Demographics
NPI:1801247879
Name:MOORE, JASON DON (BSW, LSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DON
Last Name:MOORE
Suffix:
Gender:M
Credentials:BSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5084
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7500
Mailing Address - Country:US
Mailing Address - Phone:304-255-7526
Mailing Address - Fax:
Practice Address - Street 1:120 HARPER CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2650
Practice Address - Country:US
Practice Address - Phone:304-255-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00944904104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker