Individual
AMANDA C MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
748 14TH AVE, LONGVIEW, WA 98632-2315
(360) 200-5419
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632-8455
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MC61229898
WA
Other
Enumeration date
01/04/2017
Last updated
09/30/2021
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