Individual
MRS. SUSAN I MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA,CAC-AD
Contact information
Practice address
122 LANGLEY RD N STE A, GLEN BURNIE, MD 21060-6539
(410) 222-6725
(410) 222-6748
Mailing address
1294 BRECKENRIDGE CIR, RIVA, MD 21140-1341
(410) 222-6725
(410) 222-6748
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACO239
MD
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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