Provider Demographics
NPI:1194802785
Name:MOORE, CAROLE M (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CAROLE
Other - Middle Name:M
Other - Last Name:HOAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2904 MARLOW RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7125
Mailing Address - Country:US
Mailing Address - Phone:301-890-3833
Mailing Address - Fax:
Practice Address - Street 1:1001 SPRING ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4022
Practice Address - Country:US
Practice Address - Phone:301-585-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1735103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist