Individual
TINA MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3002 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8088
(847) 984-5638
Mailing address
3002 GRAND AVE, WAUKEGAN, IL 60085-2321
(847) 377-8088
(847) 984-5638
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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