Provider Demographics
NPI:1811781198
Name:MOORE, ROBIN RENEE
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:MOORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 N WOLF CRK
Mailing Address - Street 2:
Mailing Address - City:LOVELY
Mailing Address - State:KY
Mailing Address - Zip Code:41231-8964
Mailing Address - Country:US
Mailing Address - Phone:606-626-1066
Mailing Address - Fax:
Practice Address - Street 1:4541 5TH STREET RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-9112
Practice Address - Country:US
Practice Address - Phone:304-200-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker