Provider Demographics
NPI:1982608915
Name:MOORER, NANNETTE C (LISW)
Entity type:Individual
Prefix:
First Name:NANNETTE
Middle Name:C
Last Name:MOORER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 VARDEN DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5285
Mailing Address - Country:US
Mailing Address - Phone:803-642-3801
Mailing Address - Fax:803-642-5538
Practice Address - Street 1:33 VARDEN DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5285
Practice Address - Country:US
Practice Address - Phone:803-642-3801
Practice Address - Fax:803-642-5538
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC003089104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0732Medicaid
SCQM0732Medicaid