Provider Demographics
NPI:1386167955
Name:MOORE, JAMES DALTON (MS, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DALTON
Last Name:MOORE
Suffix:
Gender:M
Credentials:MS, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 SPRINGWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4436
Mailing Address - Country:US
Mailing Address - Phone:901-305-3759
Mailing Address - Fax:
Practice Address - Street 1:117 HUXLEY RD STE B-3
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3179
Practice Address - Country:US
Practice Address - Phone:901-305-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional