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General NPI Number Information
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NPI Number | 1013554054
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Entity Type | Individual
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Provider Name | KRISSA L MOORE MS
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Gender | Female
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 23 DEASY DR
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City | NEWARK
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State | DE
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Zip | 19702-2750
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Country | US
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Telephone | 856-397-4628
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 173
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City | BEAR
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State | DE
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Zip | 19701-0173
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Country | US
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Telephone | 856-397-4628
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00702400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0011189
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License Number State | DE
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