Provider Demographics
NPI:1053429837
Name:MOORE, SUE V (MS, LPC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:V
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 TELFAIR ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5811
Mailing Address - Country:US
Mailing Address - Phone:706-722-7788
Mailing Address - Fax:706-724-8300
Practice Address - Street 1:448 TELFAIR ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5811
Practice Address - Country:US
Practice Address - Phone:706-722-7788
Practice Address - Fax:706-724-8300
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 1326103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist