Provider Demographics
NPI:1801969274
Name:MOORE, RACHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
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 1:1567 SPRINGLEAF PT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2274
Mailing Address - Country:US
Mailing Address - Phone:404-550-7560
Mailing Address - Fax:404-982-0997
Practice Address - Street 1:1758 CENTURY BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3392
Practice Address - Country:US
Practice Address - Phone:404-633-3282
Practice Address - Fax:404-982-0997
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health