Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 1795995 | GA |
NPI | 1033704937 |
---|---|
Provider Name | Carolyn Sue Moore |
First Address | Villa Rica, GA 30180-3953 |
Second Address | Carrollton, GA 30117-3870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2021 |
Last Update Date | 03/03/2021 |