Individual
AUDREA MAURINE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1506 CANNONADE CT, LUTZ, FL 33549-5822
(813) 714-9792
Mailing address
1506 CANNONADE CT, LUTZ, FL 33549-5822
(813) 714-9792
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
MH8581
FL
101YM0800X
Mental Health Counselor
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
765872900
—
FL
Enumeration date
02/15/2007
Last updated
10/19/2023
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