Individual
CHARLENE MOORER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCC, LPC
Contact information
Practice address
36 N MAIN ST, SOUTHINGTON, CT 06489-2517
(203) 919-2229
Mailing address
246 WOLCOTT RD STE 3, WOLCOTT, CT 06716-2641
(860) 329-7672
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
241420
CT
101YP2500X
Professional Counselor
Primary
46-002009
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008076655
—
CT
Enumeration date
11/13/2017
Last updated
07/26/2020
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