Individual
MRS. LISA RENEE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3005 TEASDALE RD, CHARLESTON, MS 38921-9576
(662) 809-0208
Mailing address
3005 TEASDALE RD, CHARLESTON, MS 38921-9576
(662) 809-0208
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C2276
MS
Other
Enumeration date
09/20/2021
Last updated
09/20/2021
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