Individual
JIMMY MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MSW,LCSW
Contact information
Practice address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 983-1018
(540) 224-1932
Mailing address
172 FOREST DR, SALEM, VA 24153-6860
(540) 389-1219
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904002321
VA
Other
Enumeration date
04/03/2006
Last updated
07/08/2007
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