Provider Demographics
NPI:1023502085
Name:MOORE, DAVID ISAAC (LPC, NCC, ADC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ISAAC
Last Name:MOORE
Suffix:
Gender:
Credentials:LPC, NCC, ADC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:208 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3039
Mailing Address - Country:US
Mailing Address - Phone:864-898-5800
Mailing Address - Fax:864-898-5804
Practice Address - Street 1:208 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3039
Practice Address - Country:US
Practice Address - Phone:864-898-5800
Practice Address - Fax:864-898-5804
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR122994Medicaid