Individual
MATTHEW DALE MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 HANOVER ST STE 2, LEBANON, NH 03766-1312
(603) 448-0126
(603) 448-6001
Mailing address
31 BROOK ST APT 2, BARRE, VT 05641-3457
(817) 798-5831
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106S00000X
Behavior Technician
—
TX
171M00000X
Case Manager/Care Coordinator
Primary
—
VT
175T00000X
Peer Specialist
2512019
TX
Other
Enumeration date
04/18/2019
Last updated
08/11/2020
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