Provider Demographics
NPI:1285318089
Name:MOORE, KILEXYUS BRIERRA (MSSW)
Entity type:Individual
Prefix:
First Name:KILEXYUS
Middle Name:BRIERRA
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216A N BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2711
Mailing Address - Country:US
Mailing Address - Phone:615-977-3767
Mailing Address - Fax:
Practice Address - Street 1:4000 OLYMPIA CIR STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3614
Practice Address - Country:US
Practice Address - Phone:615-977-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060140181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical