Individual
ETHEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3821 LITTLE YORK RD, DAYTON, OH 45414-2409
(937) 454-0092
Mailing address
1126 EVERGREEN PARK CT, DAYTON, OH 45458-2070
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
E0003332
OH
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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