Provider Demographics
NPI:1497097059
Name:MOORE, CARLA SMOTHERS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:SMOTHERS
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ACS NEW PARENT SUPPORT PROGRAM
Mailing Address - Street 2:BLDG 2-3602 LETTERMAN STREET
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:28310-5000
Mailing Address - Country:US
Mailing Address - Phone:910-396-7951
Mailing Address - Fax:910-907-3048
Practice Address - Street 1:BLDG 2-3602 LETTERMAN STREET
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:28310-5000
Practice Address - Country:US
Practice Address - Phone:910-396-7951
Practice Address - Fax:910-907-3048
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0075631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical