NPI | 1912436833 |
---|---|
Former Name | STARLA MARIE MOORE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304663) |
Enumeration Date | 2017-06-05 |
Last Update Date | 2020-01-03 |