Individual
MELISSA RAENAE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
1501 S MAIN ST STE H, LONDON, KY 40741-2091
(606) 393-6695
Mailing address
4 GILLIAM ST, CORBIN, KY 40701-1520
(606) 401-7647
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
275318
KY
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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