Individual
DESTINY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 CEDAR STREET, 200, MARLBOROUGH, MA 01752-0175
(919) 810-8061
Mailing address
225 CEDAR STREET, 200, MARLBOROUGH, MA 01752
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
MA
Enumeration date
03/09/2023
Last updated
03/13/2023
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