Provider Demographics
NPI:1396330445
Name:MOORE, ELIZABETH LEE (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:MOORE
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 1:1020 DORTCH LN
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-9704
Mailing Address - Country:US
Mailing Address - Phone:615-289-5316
Mailing Address - Fax:
Practice Address - Street 1:1020 DORTCH LN
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-9704
Practice Address - Country:US
Practice Address - Phone:615-289-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7992104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ073625Medicaid