Individual
DENVER SCOTT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
1680 NAVE RD SE, MASSILLON, OH 44646-9604
(308) 308-7403
(330) 830-0912
Mailing address
625 CLEVELAND AVE NW, CANTON, OH 44702
(330) 455-0374
(330) 453-6716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA175000
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0374674
—
OH
Enumeration date
10/14/2019
Last updated
09/24/2021
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