Individual
BRADLEY DALE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHPP
Contact information
Practice address
1100 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1944
(479) 263-9362
Mailing address
1100 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1944
(479) 263-9362
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
13109-M
AR
Other
Enumeration date
11/01/2007
Last updated
04/16/2025
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