Individual
MS. LORRAINE BENSON MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
4981 WATERFORD DR SW, MABLETON, GA 30126-1736
(770) 819-9314
(770) 819-9314
Mailing address
4981 WATERFORD DR SW, MABLETON, GA 30126-1736
(770) 819-9314
(770) 819-9314
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00862386A
—
GA
Enumeration date
12/27/2006
Last updated
07/08/2007
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