Individual
PORCHA MARENDA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1400 CLEVELAND ST, GREENVILLE, SC 29607-2410
(864) 467-3790
Mailing address
PO BOX 1948, GREENVILLE, SC 29602-1948
(864) 467-3790
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
570542729
—
SC
Enumeration date
09/09/2022
Last updated
09/09/2022
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