Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003341678 |
---|---|
Provider Name | Ms. Hayley Moore |
First Address | Portland, OR 97210-2872 |
Second Address | Portland, OR 97205-2327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 24/04/2017 |