Individual
EZREAL SHANTEZ MOOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 W TRADE ST, CHARLOTTE, NC 28202-1143
(704) 440-3580
Mailing address
5317 ROBERTA CROSSING DR, CONCORD, NC 28027-5714
(704) 232-8668
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1348804
NC
Other
Enumeration date
08/13/2025
Last updated
08/13/2025
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