Individual
MRS. LATISHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
139 W 3RD STREET, WASHINGTON, NC 27889-3565
(252) 940-7260
(252) 940-7261
Mailing address
139 W 3RD STREET, WASHINGTON, NC 27889-4970
(252) 940-7260
(252) 940-7261
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
Primary
—
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
MHL-007-062
NC
Other
Enumeration date
12/24/2006
Last updated
01/07/2008
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