Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1063704369 |
---|---|
Provider Name | Holly E Moore |
First Address | Mansfield, MA 02048-1322 |
Second Address | Mansfield, MA 02048-1322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2011 |
Last Update Date | 05/05/2011 |