Individual provider · Type 1 NPI
Derryck Vancurk Moore, LADC
Addiction (Substance Use Disorder) Counselor · Plymouth, MN
NPI number
1336381599
Active
Practice location
12400 25th Ave N
Plymouth, MN 55441-4008
Fax (952) 405-8090
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 301674 (MN) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
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About NPI 1336381599
Derryck Vancurk Moore, LADC's National Provider Identifier is 1336381599, issued on Apr 1, 2009. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Plymouth, MN. The record was last updated on Apr 1, 2009.