Individual
LACY D MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
612 N 11TH ST, QUINCY, IL 62301-2662
(217) 224-9484
(217) 228-8765
Mailing address
612 N 11TH ST, QUINCY, IL 62301-2662
(217) 224-9484
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150.109929
IL
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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