Organization
K & M WELLNESS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LATREASE R MOORE PHD (CO-OWNER)
(315) 220-0603
Entity
Organization
Contact information
Practice address
#186 MOHAWK ACRES PLAZA, 1756 BLACK RIVER BLVD, ROME, NY 13440
(315) 220-0603
Mailing address
#186 MOHAWK ACRES PLAZA, 1756 BLACK RIVER BLVD, ROME, NY 13440
(315) 220-0603
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
07/17/2023
Last updated
07/27/2023
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