Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003175241 |
---|---|
Provider Name | Shannon Moser |
First Address | Gainesville, FL 32608-4006 |
Second Address | Gainesville, FL 32608-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 09/05/2012 |