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General NPI Number Information
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NPI Number | 1922788520
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Entity Type | Individual
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Provider Name | STEVIE NICOLE MOORE PEER SUPPORT
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Gender | Female
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 4977 NORTHCUTT PL
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City | DAYTON
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State | OH
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Zip | 45414-3839
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Country | US
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Telephone | 937-387-6395
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Fax |
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Provider Business Mailing Address
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Address Line | 2215 GRIERSON PL
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City | FAIRBORN
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State | OH
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Zip | 45324-2725
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Country | US
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Telephone | 937-250-2826
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | APS.004087
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License Number State | OH
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