Individual
CHARLES MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
55 ELM ST, GLENS FALLS, NY 12801-3549
(518) 793-7273
(518) 798-5004
Mailing address
11 TALLOW WOOD CT, CLIFTON PARK, NY 12065-2806
(518) 369-6962
(518) 952-8287
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3689
NY
Other
Enumeration date
04/02/2012
Last updated
11/20/2020
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