| NPI | 1417460916 |
|---|---|
| Former Name | JESSICA MICHELLE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL mh17958) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC0015855) |
| 101YM0800X Counselor, Mental Health (Licence: GA 0015551) | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2023-03-31 |