Provider Demographics
NPI:1609754217
Name:MOORE, CARLIA D (BA)
Entity type:Individual
Prefix:
First Name:CARLIA
Middle Name:D
Last Name:MOORE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BLARE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-7312
Mailing Address - Country:US
Mailing Address - Phone:386-682-8253
Mailing Address - Fax:
Practice Address - Street 1:104 LACOSTA LN STE 120
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-8160
Practice Address - Country:US
Practice Address - Phone:386-274-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker