Most Relevant Information
Provider Data
NPI Number: | 1003473026 |
Provider Name: | GREGORY P MOODY LADC |
Entity Type: | Individual |
Taxonomy Code: | 101Y00000X |
Specialty: | Counselor |
License Number: | CAC6402 |
Most Important Dates
Enumeration Date: | 05/24/2019 |
Last Updated: | 05/27/2021 |
Provider Practice Location
180 ACADEMY ST STE 2
PRESQUE ISLE
ME
047693183
Practice Location Phone/Fax
Phone: | 2077643319 |
Fax: | 2077685377 |
Provider Mailing Location
180 ACADEMY ST STE 3
PRESQUE ISLE
ME
047693183
Provider Mailing Phone/Fax
Phone: | 2075542352 |
Fax: | 2075542351 |