Individual
DENISE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, LCAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000624A
IN
104100000X
Social Worker
3305215A
IN
1041C0700X
Clinical Social Worker
Primary
34006718A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100462120
—
IN
Enumeration date
06/19/2007
Last updated
12/23/2013
Update your record
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