Provider Demographics
NPI:1215313135
Name:MOORE, ANTHONY (LCPC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 HIGHWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2307
Mailing Address - Country:US
Mailing Address - Phone:202-494-0955
Mailing Address - Fax:
Practice Address - Street 1:7931 PENN RANDALL PL
Practice Address - Street 2:SUITE D3
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2666
Practice Address - Country:US
Practice Address - Phone:202-494-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional