Individual
SUZANNE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 LAUREL ST, COLUMBIA, SC 29201-2500
(301) 821-5357
Mailing address
1400 LAUREL ST, COLUMBIA, SC 29201-2500
(301) 821-5357
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-21462
SC
222Q00000X
Developmental Therapist
—
—
Other
Enumeration date
11/16/2015
Last updated
11/19/2020
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