| NPI | 1679806533 |
|---|---|
| Former Name | MICHELLE RENEE WIDOWS MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6699) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 3155) |
| 103T00000X Psychologist (Licence: FL PY6699) | |
| 103TC0700X Psychologist, Clinical (Licence: CO 3155) | |
| 103TH0004X Psychologist, Health (Licence: FL PY669) | |
| 103TH0004X Psychologist, Health (Licence: CO 3155) | |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2024-05-01 |