Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC-0001009 | DE |
NPI | 1003431594 |
---|---|
Provider Name | Lavonya Ann Moore |
First Address | Middletown, DE 19709 |
Second Address | Wilmington, DE 19809-2042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2020 |
Last Update Date | 10/06/2020 |