Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 267954789657 | AR |
NPI | 1205419207 |
---|---|
Provider Name | Carlton J Moore |
First Address | Jonesboro, AR 72401-4492 |
Second Address | Jonesboro, AR 72401-4492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2367856 | (05) | AR |