Individual
MR. GEORGE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
101 D AVENUE, ZUNI, NM 87327
(505) 782-4710
(505) 782-5880
Mailing address
PO BOX 339, ZUNI, NM 87327-0339
(505) 782-4710
(505) 782-5880
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0110951
NM
Other
Enumeration date
04/01/2009
Last updated
04/01/2009
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