Individual
EBONY STAR BAKER-MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD,LPC,MFT
Contact information
Practice address
316 ALEXANDER STREET, SUITE 2, DOUGLASVILLE, GA 30134-7205
(404) 597-9910
(888) 908-7984
Mailing address
3486 MCKOWN RD, DOUGLASVILLE, GA 30134-2812
(404) 597-9910
(888) 908-7984
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC007289
GA
101YP2500X
Professional Counselor
Primary
LPC007289
GA
Other
Enumeration date
05/01/2013
Last updated
12/18/2025
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