Individual
MRS. KRISHNA SANTASHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
612 MARION BLVD, FOREST, MS 39074-3225
(601) 604-0519
Mailing address
612 MARION BLVD, FOREST, MS 39074-3225
(601) 604-0519
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C6811
MS
Other
Enumeration date
10/07/2014
Last updated
10/07/2014
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