Individual
STEVIE NICOLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PEER SUPPORT
Contact information
Practice address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(937) 387-6395
Mailing address
2215 GRIERSON PL, FAIRBORN, OH 45324-2725
(937) 250-2826
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
APS.004087
OH
Other
Enumeration date
07/19/2023
Last updated
07/31/2023
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