| NPI | 1295316313 |
|---|---|
| Former Name | JENNIFER LYNN MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 13039-RAC) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-04-20 |