Provider Demographics
NPI:1902055775
Name:MOORE, SHENIKKA TAMSIN (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:SHENIKKA
Middle Name:TAMSIN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 NAYLOR RD SE
Mailing Address - Street 2:APT 201
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1678
Mailing Address - Country:US
Mailing Address - Phone:860-916-7400
Mailing Address - Fax:
Practice Address - Street 1:1629 K ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1602
Practice Address - Country:US
Practice Address - Phone:202-779-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040076311041C0700X
DCLC500790961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical