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General NPI Number Information
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NPI Number | 1144230848
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Entity Type | Individual
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Provider Name | DAVID MOORE
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 VETERANS AVE
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City | BILOXI
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State | MS
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Zip | 39531-2410
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Country | US
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Telephone | 228-523-5776
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Fax | 228-523-4521
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Provider Business Mailing Address
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Address Line | 2259 CLUB MOSS CIR
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City | BILOXI
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State | MS
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Zip | 39532-3325
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Country | US
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Telephone | 228-594-0072
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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