Individual
ANTRANETTE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2626 E 46TH ST, INDIANAPOLIS, IN 46205-2380
(317) 475-9066
Mailing address
2626 E 46TH ST, INDIANAPOLIS, IN 46205-2380
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
351866298
—
IN
Enumeration date
02/24/2016
Last updated
02/24/2016
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