Individual
MISS VALAIRE LATRISHA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 CAMELLIA CT, JACKSON, GA 30233-1108
(770) 570-7830
Mailing address
130 CAMELLIA CT, JACKSON, GA 30233-1108
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
562615
GA
Other
Enumeration date
05/28/2020
Last updated
03/28/2023
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