Provider Demographics
NPI:1447340518
Name:MOORE, DONNA LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40406
Mailing Address - Street 2:CENTERSTONE ASSOC
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-0406
Mailing Address - Country:US
Mailing Address - Phone:615-463-4174
Mailing Address - Fax:615-460-4189
Practice Address - Street 1:1600 WESTGATE CIRCLE STE 295
Practice Address - Street 2:CENTERSTONE ASSOC
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-661-4443
Practice Address - Fax:615-370-2408
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP02182103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist