Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | MD75050 | MD |
NPI | 1053875989 |
---|---|
Provider Name | Dr. Sheila Moore |
First Address | Prince Frederick, MD 20678-6128 |
Second Address | Prince Frederick, MD 20678-6128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2019 |
Last Update Date | 24/01/2019 |