Individual
MS. CAROLYN SMITH MOORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5713 VICKERY BLVD, DALLAS, TX 75206-6333
(214) 215-1517
Mailing address
5713 VICKERY BLVD, DALLAS, TX 75206-6333
(214) 215-1517
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
66113
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
66113
TX
101YM0800X
Mental Health Counselor
66113
TX
101YP2500X
Professional Counselor
66113
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14078740
CAQH
TX
Enumeration date
12/04/2017
Last updated
12/04/2017
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