Individual
LAURA MOONEYHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5060 N 19TH AVE # 317-6, PHOENIX, AZ 85015-3210
(843) 632-2165
Mailing address
5310 BRANTWOOD DR, MULLINS, SC 29574-6806
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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