Individual
SHANNON DAVID MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 BROADWAY ST, FREDERICK, MD 21701-6695
(240) 801-7799
Mailing address
16628 SHEA LN, GAITHERSBURG, MD 20877-1232
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/03/2024
Last updated
05/03/2024
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