Individual
QUEEN SHANICE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8 SUMMER ST, FITCHBURG, MA 01420-5717
(774) 633-9009
Mailing address
49 SIMONDS ST APT 1, FITCHBURG, MA 01420-2460
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18677
MA
101YM0800X
Mental Health Counselor
LMHC10001663
MA
Other
Enumeration date
03/11/2016
Last updated
02/05/2024
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