Provider Demographics
NPI:1992249379
Name:MOISE, KATHIE A (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHIE
Middle Name:A
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 1:4939 JAMESTOWN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5229
Mailing Address - Country:US
Mailing Address - Phone:225-924-6621
Mailing Address - Fax:225-924-6627
Practice Address - Street 1:4939 JAMESTOWN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-5229
Practice Address - Country:US
Practice Address - Phone:225-924-6621
Practice Address - Fax:225-924-6627
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical