Individual
MARY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC/LICDC
Contact information
Practice address
446 MORGAN ST, CINCINNATI, OH 45206-2348
(513) 834-7063
(513) 873-1567
Mailing address
4600 MONTGOMERY RD STE 400, CINCINNATI, OH 45212-2600
(833) 510-4357
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.161907
OH
101YP2500X
Professional Counselor
Primary
E.2202957
OH
Other
Enumeration date
09/12/2016
Last updated
08/15/2023
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