Provider Demographics
NPI:1194122473
Name:MOORE, CARMELLA I (LMHC)
Entity type:Individual
Prefix:
First Name:CARMELLA
Middle Name:I
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SE TREASURE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5773
Mailing Address - Country:US
Mailing Address - Phone:772-208-9447
Mailing Address - Fax:772-408-9619
Practice Address - Street 1:2900 SE TREASURE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5773
Practice Address - Country:US
Practice Address - Phone:771-208-9447
Practice Address - Fax:772-408-9619
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health