Individual
KANESHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
Primary
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
11/05/2013
Last updated
11/05/2013
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