Basic Information
| Provider Information | |||||||||
| NPI: | 1497247241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLOYD-MOORE | ||||||||
| FirstName: | LUDIE | ||||||||
| MiddleName: | KATHLEEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1090 | ||||||||
| Address2: | |||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295511090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438570111 | ||||||||
| FaxNumber: | 8438570206 | ||||||||
| Practice Location | |||||||||
| Address1: | 737 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SOCIETY HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295938972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433784502 | ||||||||
| FaxNumber: | 8433784209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2018 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 12605 | SC | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.