Provider Demographics
NPI:1982964821
Name:MOORE, SUZANNE PEERS (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:PEERS
Last Name:MOORE
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 CAREY STREET
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635
Mailing Address - Country:US
Mailing Address - Phone:864-512-1810
Mailing Address - Fax:864-512-8619
Practice Address - Street 1:93 CAREY ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1435
Practice Address - Country:US
Practice Address - Phone:864-512-1810
Practice Address - Fax:864-512-8619
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional