Individual
CARRIE RENAE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
6321 23RD AVE, KENOSHA, WI 53143-4805
(262) 671-1625
(866) 719-3024
Mailing address
1826 N MAIN ST, RACINE, WI 53402-4711
(262) 752-8659
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20205-130
WI
Other
Enumeration date
09/26/2024
Last updated
10/29/2024
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