Individual
SAMANTHA L MOOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
807 FAIRVIEW AVE, COLUMBIA, MO 65201-4541
(484) 888-5359
Mailing address
807 FAIRVIEW AVE, COLUMBIA, MO 65201-4541
(484) 888-5359
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2020006111
MO
Other
Enumeration date
11/02/2017
Last updated
08/04/2022
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