Provider Demographics
NPI:1679762629
Name:MOORE, CARLA S (LPC, CADC II)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W. HOLME
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654
Mailing Address - Country:US
Mailing Address - Phone:785-877-5101
Mailing Address - Fax:785-877-3903
Practice Address - Street 1:709 W. HOLME
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654
Practice Address - Country:US
Practice Address - Phone:785-877-5101
Practice Address - Fax:785-877-3903
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC 1917101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)