Individual
DERRICK MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
631 N 10TH ST, PHILADELPHIA, PA 19123-2601
(267) 223-9010
Mailing address
631 N 10TH ST, PHILADELPHIA, PA 19123-2601
(267) 223-9010
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/29/2015
Last updated
10/29/2015
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