Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LCP5663 | MD |
NPI | 1003224304 |
---|---|
Provider Name | Ms. Pamela Moody |
First Address | Clinton, MD 20735-3630 |
Second Address | Clinton, MD 20735-3630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2014 |
Last Update Date | 30/07/2014 |