Individual
MRS. KEISHA MCCLEESE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2962 YOUTH UNLIMITED DR, SOPHIA, NC 27350-8481
(336) 861-9243
Mailing address
1052 GLENMONT RD, WINSTON SALEM, NC 27107-1561
(336) 978-4911
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A10870
NC
Other
Enumeration date
10/14/2014
Last updated
07/18/2019
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