Individual provider · Type 1 NPI

Jackie Moore, MA

Addiction (Substance Use Disorder) Counselor · Grosse Pointe, MI

NPI number 1629355870 Active

Practice location

18530 Mack Ave Ste 101
Grosse Pointe, MI 48236-3254

Call (313) 673-9073 Map

Fax (313) 884-8442

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X6401007537 (MI)
Counseling Psychologist 103TC1900X6301005272 (MI)

Addiction (Substance Use Disorder) Counselor: Definition to come...

About NPI 1629355870

Jackie Moore, MA's National Provider Identifier is 1629355870, issued on Nov 15, 2011. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Grosse Pointe, MI. The record was last updated on Nov 15, 2011.