Individual
MRS. STEPHANIE JADE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ADC
Contact information
Practice address
1104 VINE STREET, BATESVILLE, AR 72501-8638
(870) 613-6624
Mailing address
1104 VINE STREET, BATESVILLE, AR 72501-8638
(870) 613-6624
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1641
AR
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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