Individual
PATRICIA DIAHANN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
133 CHEESMAN LAKE CIR, DIVIDE, CO 80814-9776
(719) 686-1781
Mailing address
PO BOX 17613, COLORADO SPRINGS, CO 80935-7613
(719) 686-1781
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
NLC0011260
CO
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACB0007760
CO
Other
Enumeration date
01/15/2016
Last updated
01/15/2016
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