Individual
DIANNE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
114 S MAIN ST, LANCASTER, SC 29720-2442
(803) 285-6911
Mailing address
PO BOX 1627, LANCASTER, SC 29721-1627
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M00085SCL
—
SC
Enumeration date
11/20/2014
Last updated
11/20/2014
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