Provider Demographics
NPI:1386815249
Name:MOORE, CARRIE JOHNSTON (LCSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JOHNSTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:532 SILICON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9018
Mailing Address - Country:US
Mailing Address - Phone:817-609-4080
Mailing Address - Fax:
Practice Address - Street 1:532 SILICON DR STE 102
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9018
Practice Address - Country:US
Practice Address - Phone:817-609-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07004581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical