Individual
LARRY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHA
Contact information
Practice address
620 N CHURCH ST APT 1603, CHARLOTTE, NC 28202-3299
(330) 209-7118
Mailing address
620 N CHURCH ST APT 1603, CHARLOTTE, NC 28202-3299
(330) 209-7118
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
10/31/2018
Last updated
10/31/2018
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