Individual
CHARLEEN M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1101 N ROYAL AVE, SUITE B, EVANSVILLE, IN 47715-7845
(812) 402-0020
(812) 402-0023
Mailing address
1101 N ROYAL AVE, SUITE B, EVANSVILLE, IN 47715-7845
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34002294A
IN
106H00000X
Marriage & Family Therapist
35000786A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185606
ANTHEM PIN
IN
01
—
11495407
CAQH
IN
Enumeration date
07/14/2006
Last updated
08/20/2013
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