Most Relevant Information
Provider Data
| NPI Number: | 1003467796 |
| Provider Name: | LATISE MOORE |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | C012178 |
Most Important Dates
| Enumeration Date: | 09/24/2019 |
| Last Updated: | 09/24/2019 |
Provider Practice Location
9336 KINGS PARADE BLVD APT 3225
CHARLOTTE
NC
282735858
Practice Location Phone/Fax
| Phone: | 7575356678 |
| Fax: |
Provider Mailing Location
9336 KINGS PARADE BLVD APT 3225
CHARLOTTE
NC
282735858
Provider Mailing Phone/Fax
| Phone: | 7575356678 |
| Fax: |