Provider Demographics
NPI:1811147366
Name:MOORE, CAROL L (MA; LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA; LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 MARS HILL RD NW STE 124-308
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7127
Mailing Address - Country:US
Mailing Address - Phone:678-919-1077
Mailing Address - Fax:678-317-3991
Practice Address - Street 1:1720 MARS HILL RD NW
Practice Address - Street 2:STE. 124-308
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7127
Practice Address - Country:US
Practice Address - Phone:678-919-1077
Practice Address - Fax:678-317-3991
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005351101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health