Individual
CHARLY A MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDPT
Contact information
Practice address
614 PETERSON RD, BURLINGTON, WA 98233-2606
(360) 757-0131
Mailing address
1730 LABOUNTY DR # 9-248, FERNDALE, WA 98248-8959
(360) 510-2996
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60996036
WA
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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