Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TC1900X | Counseling Psychologist |
NPI | 1114236619 |
---|---|
Provider Name | Dr. Charles Ray Moore |
First Address | Dallas, TX 75231-4177 |
Second Address | Dallas, TX 75231-4177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 30/09/2010 |