Individual
MICHAEL THOMAS MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
920 BELVIEW ST. SE, WASHINGTON, DC 20032
(202) 562-4939
Mailing address
15616 GILPIN MEWS LN, BRANDYWINE, MD 20613-6277
(240) 893-2491
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CACI1135
DC
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121313
—
DC
05
—
123152
—
MD
Enumeration date
04/28/2020
Last updated
04/28/2020
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