Individual
MS. NICOLE SULLIVAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1531 13TH ST, SUITE 2540, COLUMBUS, IN 47201-1300
(812) 372-3745
(812) 372-5367
Mailing address
PO BOX 1002, COLUMBUS, IN 47202-1002
(812) 372-3745
(812) 372-5367
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34003909A
IN
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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