Provider Demographics
NPI:1871970194
Name:MOORE, THOMAS EDWARD (CAC II)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:MOORE
Suffix:
Gender:
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 S ST SE APT A8
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1009
Mailing Address - Country:US
Mailing Address - Phone:202-560-8706
Mailing Address - Fax:202-388-8509
Practice Address - Street 1:2112 F ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2715
Practice Address - Country:US
Practice Address - Phone:202-560-8706
Practice Address - Fax:202-388-8509
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACII1000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)