Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003293549 |
---|---|
Provider Name | Mrs. Wendy Moreno |
First Address | Chattanooga, TN 37409-1379 |
Second Address | Chattanooga, TN 37409-1379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2015 |
Last Update Date | 26/08/2020 |