Provider Demographics
NPI:1306921697
Name:MOISE, CAROL EVERHART (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:EVERHART
Last Name:MOISE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5908 STUMBERG LN
Mailing Address - Street 2:APT 19
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6370
Mailing Address - Country:US
Mailing Address - Phone:225-933-8273
Mailing Address - Fax:
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5922
Practice Address - Country:US
Practice Address - Phone:225-925-1906
Practice Address - Fax:225-362-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33891041C0700X
MSC65541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical