Individual
AMANDA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4747 MONROE ST, TOLEDO, OH 43623-4307
(833) 440-8640
Mailing address
4747 MONROE ST, TOLEDO, OH 43623-4307
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OH
101YM0800X
Mental Health Counselor
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0422070
—
OH
Enumeration date
10/20/2020
Last updated
04/22/2021
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