Individual
CHARLES B MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW-C
Contact information
Practice address
2 WATER ST, HOULTON, ME 04730-2126
(207) 532-5510
(207) 532-5518
Mailing address
328 CALLAGHAN RD, HOULTON, ME 04730
(207) 532-2405
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
LSX7340
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259340099
—
ME
Enumeration date
05/23/2007
Last updated
10/09/2014
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