Individual
TANZANIA MALA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3530 MANOR DR STE 5A, VICKSBURG, MS 39180-5625
(601) 738-5260
(601) 738-5361
Mailing address
234 BAUGH ST, PEARL, MS 39208-4103
(769) 572-5548
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
MS
Other
Enumeration date
06/30/2018
Last updated
06/30/2018
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