Individual
DUSTIN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAA
Contact information
Practice address
511 E 20TH ST, FARMINGTON, NM 87401-2105
(505) 564-3733
Mailing address
511 E 20TH ST, FARMINGTON, NM 87401-2105
(505) 564-3733
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0195451
NM
Other
Enumeration date
03/28/2018
Last updated
03/28/2018
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