Individual
MS. KONNIESHA M MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
622-624 VALLEY RD STE 6D, UPPER MONTCLAIR, NJ 07043-1462
(862) 621-0833
Mailing address
68 PROSPECT ST, BLOOMFIELD, NJ 07003-3225
(862) 621-0833
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
37FI00177900
NJ
Other
Enumeration date
11/01/2017
Last updated
11/01/2017
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