Individual
MR. TONY CURTIS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC,CCS
Contact information
Practice address
6723 17TH AVE, KENOSHA, WI 53143-4914
(262) 605-8442
(262) 605-8460
Mailing address
6723 17TH AVE, KENOSHA, WI 53143-4914
(262) 605-8442
(262) 605-8460
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
10820-132
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13313-135
WI
Other
Enumeration date
05/02/2008
Last updated
05/02/2008
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