Individual
COLLEEN UNA MOODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DSP CRMA
Contact information
Practice address
198 BIRMINGHAM RD, CHELSEA, ME 04330
(207) 582-0016
(207) 582-0016
Mailing address
198 BIRMINGHAM RD, CHELSEA, ME 04330
(207) 582-0016
(207) 582-0016
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
ALL53665
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209330000
—
ME
Enumeration date
11/04/2009
Last updated
11/09/2009
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