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NPI Code Detail

MEDICARE: TAMIKA MOORE

MEDICARE: TAMIKA MOORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1568907608
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMIKA MOORE
Provider Business Mailing Address
First Line : 5663 S LABURNUM AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23231-4418
Country : US
Telephone Number : 804-737-3917
Fax Number : 804-737-3940
Provider Business Practice Location Address
First Line : 5663 S LABURNUM AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23231-4418
Country : US
Telephone Number : 804-737-3917
Fax Number : 804-737-3940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2016
Last Update Date : 12/28/2016

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Directions to “ TAMIKA MOORE ” Practice Location

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