Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MHC00908 | RI |
NPI | 1003050121 |
---|---|
Provider Name | Kristy Moles |
First Address | Woonsocket, RI 02895-0856 |
Second Address | Woonsocket, RI 02895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 11/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GH57134 | (05) | RI |