Individual
CHARLESZETTA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP
Contact information
Practice address
4409 DISRAELI DR APT 5101, FORT WORTH, TX 76119-5851
(817) 585-0664
Mailing address
5125 WICHITA ST UNIT 15407, FORT WORTH, TX 76119-2501
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
TX
171W00000X
Contractor
—
TX
172V00000X
Community Health Worker
—
TX
251B00000X
Case Management Agency
Primary
—
TX
372600000X
Adult Companion
—
TX
373H00000X
Day Training/Habilitation Specialist
—
TX
Other
Enumeration date
11/01/2022
Last updated
11/01/2022
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