Provider Demographics
NPI:1083818256
Name:MOORE, STEVEN A (LCPC,LPC-S, NCC, MAC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:A
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCPC,LPC-S, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BEALMEAR MILL LN APT 6103
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2999
Mailing Address - Country:US
Mailing Address - Phone:713-299-7404
Mailing Address - Fax:
Practice Address - Street 1:2020 BEALMEAR MILL LN APT 6103
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2999
Practice Address - Country:US
Practice Address - Phone:713-299-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63996101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
MDLC11365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100249753-00Medicaid