| NPI | 1700246709 |
|---|---|
| Former Name | KIMBERLY DIANE MOSS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: GA CSW005573) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA C0159) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2016-06-24 |